Leading By Example
Mental Health Today Conference November 2005
Dog's As therapy
Mind Conference , March 2006
VONNE, SURF ID 1072
Trash The Ash?? Report
‘Our Future – Doing it for Ourselves’
Service Users Interviewing Staff
Mental Health North East
Experiencing Mental Health Problems
Independent Mental Capacity Advocacy
Lanchester Road Hospital Briefing July 2006
One Person- Many Perspectives
Smoking Policy For Mental Health Trusts
Letter To All Service Users Who Use Chester-le-Street CMHT
Meeting of the Smokefree Trust Project Group
Contact Information for Service Users Reaching Forward
Links for Service Users Reaching Forward
Do you believe all mental health facilities should be non-smoking?
Smoke free NHS: Challenges for Mental Health Trusts Seminar
Smoke free NHS: Challenges for Mental Health Trusts Seminar
20th July 2006
The reason for being at this conference was the recent decision by the Tees, Esk & Wear Valleys NHS Trust to adopt a non smoking policy. Such a policy has major consequences for the large proportion of mental health service users who suffer from severe mental health conditions and who smoke. Particularly service users who are being treated whilst under a section or who are living in trust premises for a long period of time.
By the time this event was held the government had published the regulations/guidance to accompany the Health Bill which alongside ‘Choosing Health’ is determining the push to reduce the prevalence of smoking in the community as a whole. There are two points of particular interest in the guidance for mental health trusts.
1. Any mental health facility or part of an establishment where the average length of stay is equal to or greater than 6 months can continue to have a smoking room.
2. The regulations only cover buildings and vehicles; they do not prohibit smoking on NHS grounds.
These exemptions do not necessarily mean that the Trust will change its currently approved policy which would ban smoking totally from grounds and premises. However, the Tobacco Control Collaborative supported by the Department of Health is strongly advising trusts to continue to allow smoking in the grounds of mental health establishments. Lynn Oliver, who within the Tees, Esk and Wear Valleys NHS Trust (TEWVs) is charged with developing and actioning their smoking policy will review the policy in the light of these exemptions with Harry Cronin, Director of Nursing, Psychology and Allied Health Professionals for TEWVs. If they feel a change in the policy is justified the policy will have to go back before the Trust Board as the Board has already approved the policy as it currently stands.
My personal view is that both these exemptions need to be adopted; most particularly the one which permits smoking in the grounds. This would answer many of the questions service users have about what happens when you are detained in hospital; it would go some way to lessening the fears that many people have expressed about contacting services if they are to be stopped from smoking. It would allow long stay patients for whom trust premises are basically their home to continue to smoke; if they wish (assuming problems of staff time could be overcome where a patient needs escorting). This would also meet the objections of staff and service users who don’t smoke and object to the smell and potential adverse affects on their health. These exemptions also meet freedom of choice objections.
Central to all non-smoking policies has to be the delivery of good quality & timely support for people wishing to give up smoking. Hilary Wareing of the Tobacco Control Collaborating Centre emphasised the need for:
1. Good staff training to level 2 cessation support qualification standard. (For all trusts there is the question of capacity and funding for training.)
2. Advised that one member of staff be qualified to level 3 to give more advanced support/advice to staff dealing with smoking cessation.
3. A need for at least 3 members of staff on each ward to receive training to ensure sufficient backup.
4. The provision of Nicotine Replacement Therapy (NRT), which must be stocked on the wards so as to be available as and when needed.
5. Other areas have reported problems with NRT gun being used to block locks, sprays containing dangerous components made of glass and non clear patches being used to hide blades so these forms of NRT are not recommended.
6. Good promotion of the policy in advance of implementation and the provision of tools which help staff enforce the policy in a non confrontational manner i.e. the provision of credit card sized reminders of the policy for people caught smoking in non smoking areas.
Neil Johnson of the Care Service Improvement Partnership (CSIP) attempted to dispel what he referred to as the myths smokers have about smoking; that it:
1. Helps relieve stress and anxiety; Neil’s point was that smokers have been shown to exhibit higher levels of stress.
2. People become aggressive when they stop smoking; Neil claims that there is no evidence of this. Neil’s point was mainly around the removal of aggressive competition for cigarettes on wards when people finish their own supply.
3. Smoking helps symptoms of psychosis; Neil, “Attempts to stop smoking do not appear to exacerbate psychotic symptoms”.
In a sense I don’t think it matters whether these ‘myths’ are true or not we are dealing with people’s perceptions rather than the objective truth. It still leaves people dealing with the very real symptoms of withdrawal from a very powerful drug at a time when they will be anxious going into a hospital (possibly for the first time) and when they are enduring a severe illness. This would be less of a problem if the Trust takes advantage of the potential exemption allowing smoking in the grounds of mental health properties.
The argument that mental health service users should be included in any work to improve the physical and mental health of the nation is unarguable. My question is: is the moment of maximum anxiety (going into hospital) and suffering from severe illness (and if they aren’t they shouldn’t be in a hospital) the moment to start people through the intense process of withdrawal from one of the most addictive drugs known?
I would also question the reliance on local smoking cessation services in primary care for people once they leave hospital. Many service users have completely disengaged with primary care, having had what they consider to be at best a very poor deal from their G.P. If someone has started on the road to giving up smoking in hospitals it would be a shame if they fell at this hurdle. Could mental health teams in the community not also be trained to continue smoking cessation work and supply NRT for those people unwilling to use primary care services?
Lynn Oliver is to carry out a service user information gathering exercise using a questionnaire which initially she suggested would be through the Patient Public Involvement Forum. That is certainly one route, but I suggested that contacts be made with service users through local groups and service user ward meetings (these already operate). I have information on what groups exist in the County Durham and Darlington but only with regard to Adult Mental Health and not in the south of the region.
The Trust is to establish a project group to carry out the bulk of the work and an executive steering group. The PPI Forum has asked to be on both of these bodies and service users would probably also like to have direct representation.
Notes for information:
www.rethink.org ‘Resolve To Stop Smoking’ and ‘Smoking and Mental Illness Factsheet’
www.kingsfund.org.uk ‘Clearing the Air’
Mark Henderson, report for SURF & TEWvs PPI Forum 21st July 2006