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Clearing the Air

Clearing the Air. Developing Comfort and Skill to Address Tobacco Cessation and Reduction Needs Presented by Amy F. Rogers. Today’s Agenda. Enhance knowledge and understanding of the relationship between tobacco use and mental health Watch video interview with client Pollianna Frost 

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Clearing the Air

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  1. Clearing the Air Developing Comfort and Skill to Address Tobacco Cessation and Reduction Needs Presented by Amy F. Rogers

  2. Today’s Agenda • Enhance knowledge and understanding of the relationship between tobacco use and mental health • Watch video interview with client Pollianna Frost  • Learn and practice a cessation/reduction intervention strategy • Problem-solve creating “quit friendly” environments • Wrap up

  3. Tobacco Use in the Mental Health Community • Cigarettes consumed by smokers with a mental illness account for nearly half (44.3%) of all cigarettes consumed in America. Adler, Olincy, et al. Schizophrenia Bulletin 24:196.1998 • The average life expectancy of a mental health consumer is only 51 years old! (largely due to smoking-related illness vs. the MH diagnosis) Manderscheid, Colton, et al. Behavioral Healthcare 2008 • For mentally ill clients 25-44 years old, heart disease was 7x higher than peers and more than 7x the suicide rate.Department of Mental Health, Massachusetts, 2001.

  4. Tobacco Use in the Mental Health Community • Recent studies show that smoking may precede mental illness. Boyd, W.J., et al. Psychiatric Times. 2001. Vol. XVII, Issue 10. • Abstinence from tobacco is shown to be related to longer post-treatment abstinence from drugs and alcohol. (Stuyt, 1998; Sobel, 1996; NIDA Research Update, 2/2000) • Smoking often influences the impact of psychotropic medications. Smokers may need higher doses, which can produce more negative side effects. Lasser, K., et al. JAMA, 284:2606-2610. November 2000

  5. What is Recovery?

  6. What is Recovery? • Symptom management • Medication balancing • Feeling more “a part of” • Self-esteem • Sense of self-efficacy, independence • Safe and pleasant housing • Work ~ volunteer and paid • School • Community

  7. How Does Smoking Interfere? • Adverse physical health consequences; robs energy • Erodes self-esteem; persistent sense of being “stuck”, unable to make positive life changes • Burns up precious money and time (often gobbles up 100% of discretionary income!) • Stifles imagination and diminishes resources for developing other interests

  8. How Smoking Interferes (Cont’d.) • Causes smoking-related isolation, reinforcing societal marginalization • Closes off many desirable independent living choices • Turns off an increasing number of prospective employers and volunteer coordinators • Works against possibility of reducing medications and unpleasant side-effects

  9. And yet… Many people fear asking mental health clients to quit!?!

  10. But, but, but… Smoking cessation treatments work and are safe for people with severe mental illness!!!

  11. Pollianna’s Video

  12. Ask, Advise, Refer (AAR) • Ask: All clients about tobacco use • Advise: All smokers to quit immediately • Refer: All smokers to appropriate cessation services

  13. Ask: All Clients About Tobacco Use Why? • It’s very quick and easy to do • If you don’t, and they do, they feel ‘unseen’ • They may assume you don’t think they’re ‘worth it’ • They might also assume you think they can’t or won’t quit!

  14. Ask: (Cont’d.) How? • “Do you smoke or use any type of tobacco?” • “What do you already know about smoking?” • “I know you’ve been concerned about your ______ (health, finances, relationship, etc.), any thoughts on how smoking might contribute?” • “You have talked about how upsetting it is that can’t afford to go to the movies or to dinner anymore. How do you think quitting might be able to help?” • “Do you still have that goal card I gave you?”

  15. Advise: All Smokers to Quit/Reduce Why? • People respond to being ‘seen’ • People trust clinician’s advice-you have a relationship • You might be the 100th monkey • You could help save their life!

  16. Advise: (Cont’d.) How? • In a clear, strong, personalized manner • “I strongly recommend that you quit or cut down” • “Quitting is probably the single best thing you can do for your health” • “Putting together a plan will increase your chance of success”

  17. Refer: All Clients to Further Support Services Why? • Most people don’t know about all of their available resources • The more resources people employ, the better their chances of succeeding • It might be more fun and interesting than just relying on us

  18. Refer: Continued How? • “Can I show you this really cool resource list?” • “Have you been to Smoke Busters yet?” • “Did you make it to Nicotine Anonymous ?” • “Were you able to reach Beth Lillard at BACR?” • “How did it go with asking your doc for patches?” • “You know those people at 1-800-No-Butts are really nice. If you don’t get what you need from them, let me know”

  19. Questions about AAR?

  20. Role Plays

  21. Creating Quit-Friendly Environments • What exactly does Quit-Friendly mean? • What kind of environments are we talking about here? • Examples within Buckelew • Time to ‘think outside the box’ • If ‘money were no object’ • ‘In your wildest dreams’ • Make it ‘wacky and wonderful’

  22. “My vision for a fully functioning public mental health system is one that promotes living a healthy, rewarding and productive life. In order to maximize healthy living I envision a community that addresses the reality of tobacco use and its negative impact on all of us. Working together with clinicians, clients, peer providers and family partners it is my goal to create a quit-friendly environment for everyone. This quit-friendly environment will be in the spirit of hope, recovery, and resiliency and will be integrated into all parts of the community.” Bruce Gurganis Director of Mental Health, Marin County

  23. Final Words of Wisdom • People sometimes take a while to develop the confidence to try quitting (or to quit again); have patience while you gently encourage them. • Quitting smoking is a dynamic process. A recent study shows that stopping treatment too soon reduces the chance of success by 45% • Unless the client asks, refrain from focusing on the ‘scary’ stuff (Eg. photos of unhealthy lungs)

  24. Conclusion • What was the most useful part of today’s presentation? • Take a second to review your action items and decide to act on one this week! • Special note: Remember to document nicotine dependence in the chart (305.10 on Axis II) Plans, Med. Necessity, All assessments • Come join me for a quarterly meeting for continued support around this issue!

  25. Thank You!!!

  26. Amy Rogers (415) 456-9350 x106 amy@buckelew.org

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