Smoke Mirrors: Myths about Smoking Mental Illness

1. Smoke & Mirrors:Myths about Smoking & Mental Illness New Zealand Workshop Series Auckland, Wellington, Christchurch Aug 18th � 21st 2009 Dr Sharon LawnEmail: sharon.lawn@flinders.edu.au

2. Myths arise from Long-standing Complex Dilemmas: no clear answers Supply Clinical Reinforcement Systems responses Duty of Care � staff and patients OHS � aggression, ETS Suffering Responsibility Rights, Needs, Choice Addiction Economics It really isa �can of worms� with multiple intertwined forces at play. At every turn there are always 2 or more sides to the argument! Supply � a real sense that heads and bodies have become disconnected from each other. �They know not what they do!� Unmarked smokemart vans! Clinical Reinforcement � when people are highly distressed this is really hard work! And in the absence of adequately trained staff, adequately supported staff, and systems of care to understand how to clinically manage drug withdrawal, staff do what they can at the time. Little wonder Systems responses Duty of Care � staff and patients � competing claims potentially exist. Both sides (pro and anti-smoking) will use this argument. OHS � aggression, ETS � and even more competing claims. The right to safe work environments, the right to safe care environment. Hospital as home for some. Suffering � this is hard. In systems with not better options to alleviate distress and addiction, people will finding smoking provides short term solutions like no other. Responsibility � when it all gets too hard, in systems that don�t have good leadership and where staff support systems are fragmented, they start blaming each other, they retreat into the own patches, and no-one ends up taking any responsibility. Do this for decades and a healthy smoking culture develops. Rights, Needs, Choice �Interesting debates occurring in NSW currently with a particular group of consumers who are opposing the NSW Health push for smoking restrictions within their health facilities. Their main argument is that �we have no other rights except this one because of the way the system treats us� Surely, they deserve better than to be backed into a corner so much, so disempowered, that this is their last bastion of for the expression of their rights. Better quality delivery of care would seem to be a good start and systems that take responsibility and provide more skills to assist with addiction would seem necessary. The right to better care in the first place! Addiction �ultimately this is an addiction, not freely chosen by the person. It�s simply not fair. This is the bottom line. Yes, ultimately I�ve heard them all, all the arguments, and they go nowhere fast!It really isa �can of worms� with multiple intertwined forces at play. At every turn there are always 2 or more sides to the argument! Supply � a real sense that heads and bodies have become disconnected from each other. �They know not what they do!� Unmarked smokemart vans! Clinical Reinforcement � when people are highly distressed this is really hard work! And in the absence of adequately trained staff, adequately supported staff, and systems of care to understand how to clinically manage drug withdrawal, staff do what they can at the time. Little wonder Systems responses Duty of Care � staff and patients � competing claims potentially exist. Both sides (pro and anti-smoking) will use this argument. OHS � aggression, ETS � and even more competing claims. The right to safe work environments, the right to safe care environment. Hospital as home for some. Suffering � this is hard. In systems with not better options to alleviate distress and addiction, people will finding smoking provides short term solutions like no other. Responsibility � when it all gets too hard, in systems that don�t have good leadership and where staff support systems are fragmented, they start blaming each other, they retreat into the own patches, and no-one ends up taking any responsibility. Do this for decades and a healthy smoking culture develops. Rights, Needs, Choice �Interesting debates occurring in NSW currently with a particular group of consumers who are opposing the NSW Health push for smoking restrictions within their health facilities. Their main argument is that �we have no other rights except this one because of the way the system treats us� Surely, they deserve better than to be backed into a corner so much, so disempowered, that this is their last bastion of for the expression of their rights. Better quality delivery of care would seem to be a good start and systems that take responsibility and provide more skills to assist with addiction would seem necessary. The right to better care in the first place! Addiction �ultimately this is an addiction, not freely chosen by the person. It�s simply not fair. This is the bottom line. Yes, ultimately I�ve heard them all, all the arguments, and they go nowhere fast!

3. Myth 1: The Numbers The statistics on smokers with mental illness are over-rated

4. Myth 2: Priorities Smoking is one of the few pleasures for an already stigmatised population (Related Myth) Smoking is not that harmful. For people with mental illness, there are other more important harms to be concerned about. (Related Myth) If they quit they will put on more weight. (Related Myth) Passive smoking is not that harmful, so smoking areas should be allowed for psychiatric inpatients

5. Myth 3: Rights They should be given the right to choose when to quit (Related Myth) Banning smoking is an infringement of these smokers� human rights and legal rights

6. Myth 4: Self-Medication Mentally ill smokers need to smoke in order to alleviate psychiatric symptoms and anxiety (Related Myth) They need to smoke to self-medicate their illness. They started smoking to self-medicate undiagnosed mental health problems. (Related myth) Smoking improves attention and coping associated with mental illness

7. Myth 5: Relapse Attempting to quit makes symptoms worse

8. Myth 6: Choice Mentally ill smokers can�t quit (Related Myth) They choose to smoke (Related Myth) It�s dangerous for mentally ill smokers to use NRT and other smoking cessation treatments

9. Myth 7: Rapport Staff need cigarettes in order to build rapport and engage with patients. (Related Myth) Smoking between staff and patients facilitates a therapeutic relationship (Related Myth) Non-smoking staff are less likely to rely on cigarettes and are less likely to support patients smoking

10. Myth 8: Initiation Psychiatric hospitalization may lead non-smokers to become smokers (Related myth) People with mental illness are often initiated into smoking during their contact with mental health service systems

11. Myth 9: Smoke-Free Policy Smoking bans are relatively straightforward to implement

12. Myth 10: Smoke-Free Fears Smoke-free will lead to more violence towards staff and other patients (Related Myth) Smoking bans will deter mentally ill smokers from seeking admission to hospital, even when admission is needed (Related myth) Smokers will be more likely to discharge themselves prematurely and against medical advice where smoking bans are in place (Related myth) Smoking bans create an increased fire risk in inpatient settings because patients will smoke in bathrooms and toilets.

14. Myth 11: Support Bans do not lead to mentally ill smokers stopping smoking in the long term (Related Myth) During admission is not the right time to talk about quitting smoking

15. Myth 12: Quitlines Quitlines are not effective for people with mental illness (Related Myth) Mentally ill smokers don�t contact the Quitline

16. So What Do We Do? Improve understand of the interaction Address attitudes & beliefs Address staff role models / smoking rates Make support for smoking cessation core business Embed clinical management of nicotine withdrawal Build knowledge & skills Integrate support Share learning