smoking and mental health hertfordshire context
TRANSCRIPT
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Leadership and Clear Priorities: The Hertfordshire ContextSmoking Cessation and Mental Health: Implementing NICE Guidance PH48
Jim McManus, Director of Public Health
Liz Fisher, Head of Provider Services, Tobacco Control Lead
East of England Seminar, 24 March 2015
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Why Tobacco Control remains important
• Single most important cause of premature morbidity and mortality
• Kills 80,000 people prematurely in England alone and 1,500 people in Herts die every year
• Accounts for 50% of health inequalities between better and worst off
• Disproportionately affects
most deprived groups
• 135,300 smokers in Herts
• Cost the NHS £55 million in 2013-2014
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A call to action
• Gay Sutherland as Keynote at our Public Health Conference 2014 on smoking and mental health
• Here are some killer points from her....
www.hertsdirect.org Slide courtesy of Gay Sutherland
www.hertsdirect.org Slide courtesy of Gay Sutherland
www.hertsdirect.org Slide courtesy of Gay Sutherland
www.hertsdirect.org Slide courtesy of Gay Sutherland
www.hertsdirect.org Slide courtesy of Gay Sutherland
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Herts smoking attributable morbidity and mortality
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Herts smoking prevalence 2010-2013
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Herts routine and manual prevalence
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What is difficult about smoking and mental health:• Mental health care staff see smoking as less of a priority
than general NHS staff
• There remains a culture of acceptability within mental health providers
• There are no national reporting systems on stopping smoking and mental health
Myths:
• Stopping smoking has adverse effects on mental health
• Mental health service users have other priorities
• Mental health service users don’t want to stop smoking
• Mental health service users can’t stop smoking
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Reducing the harm from tobacco - HWbB and PH Priority
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The Hertfordshire Context 1• Regional smoking and mental health seminar
• CLeaR review on tobacco control
• NHS systems leaders’ commitment to tobacco control
• Herts smoking and mental health action group
• Implementing NICE PH48
• Implementing NICE PH45 – harm reduction
• Mental health and smoking master classes
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The Hertfordshire Context 2
• Developing more specialist stop smoking services –
– behavioural sciences training from motivational interviewing to sponsoring people to become Chartered Health Psychologists
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Herts Harm Reduction Guidance
• Implementing NICE PH 45 – clinical guidelines
• Stopping smoking main recommendation
• Effectiveness and cost effectiveness of harm reduction
• For smokers not ready/unable to quit in one step
• Behavioural support
• Nicotine containing products – right doses
• Role of e –cigarettes for harm reduction
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Mental Health and Primary care Project• The scale of the problem – 1:4 adults have a
mental health problem in any one year
• QOF points
• Identification of all smokers
• MECC – build confidence in ability to quit with specialist support
• Referring to specialist services
• Heavier smokers – need higher doses and longer term NRT
• Role of varenicline
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Commissioning for smoking and mental health• HPfT CQUIN 13/14
Herts.P.f.T (Mental Health)Department Total Referrals
A.O.T. 25
Community Mental Health Team (CMHT) 318
Early Intervention in Psychosis 4
Enhanced Primary Mental Health Service 2
RAID 2
Hertfordshire Commuinty Eating Disorder Service 2
TOTAL 353
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Proposed Quality Schedule metrics 15/16• All service users to have smoking status recorded
• Brief intervention advice to be given to all smokers
• All smokers to be referred to Hertfordshire Stop Smoking Service (HSSS) unless they ‘opt out’
• All staff to be asked to complete an online survey (in Q1) on attitudes to smoking and electronic cigarettes (to be provided by Hertfordshire Stop Smoking Service).
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Quality Schedule metrics15/16 cont.• All staff to be encouraged to quit smoking and
offered a referral to HSSS
• To promote campaigns such as Stoptober and National No Smoking Day with service users and staff
• Adopt Hertfordshire Tobacco Harm Reduction Guidance
• HPfT to become Smokefree by the end of 2016, with the Lister site becoming Smokefree pilot site by 1 October 2015 (plans to achieve this at the Lister are already in progress)
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Public Health
• TC Alliance – representation from mental health stakeholders
• NHS Health Checks
• Mental Health Health Checks
• Vol orgs (MIND, Viewpoint, Living Room)
• Drug and alcohol services
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Offender health• Smoking prevalence similar to mental health
clients
• 770 prisoners – but expanding
• Health of probation caseload
• Prison and specialist SSSs
• Smokefree prison/Smokefree cells
• Access to NRT for harm reduction
• Staff SSSs
• Probation action plan being developed
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PRIORITY Groups
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Next Steps
• Ensure revisions to HWb Board tobacco control priorities include mental health
• Agree QS metrics with HPfT15/16
• Improve quality of stop smoking services for metal health service users
• Implement harm reduction guidance
• Increase knowledge and skills of frontline staff and volunteers who work with mental health service users
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Tobacco Pension Investments
• ......
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Hertfordshire Masterclass for Practitioners...
Smoking and Mental Health Masterclass
Wednesday 29th April 2015
And enormous thanks to Liz Fisher, my Tobacco Control Alliance including Joel
Bonnet, and all our partners