Providing Sustainable Tobacco Providing Sustainable Tobacco Cessation Services to the Mental Cessation Services to the Mental

Health CommunityHealth Community

Beth Lillard, BABeth Lillard, BAEvelyn Castillo, MPHEvelyn Castillo, MPH

A Program of Bay Area Community Resources.A Program of Bay Area Community Resources.In collaboration with Marin County Tobacco Education In collaboration with Marin County Tobacco Education

Program. Funded by MSA.Program. Funded by MSA.

CharynCharynSuttonSutton

4.6.1947 – 12.30.20044.6.1947 – 12.30.2004

Once upon a time…..Once upon a time…..

• ‘Providers’• ‘Clients’ and ‘Patients’• a few ‘Questioners’

Questioners Questioners from the field:from the field:

• Lowell Dale, M.D., Mayo Clinic• Douglas Ziedonis,M.D., and Bernice

Order-Connors, LCSW, University of Medicine and Dentistry of New Jersey

• Phillip Gardiner, DrPH, TRDRP• SANE Australia• David Staba, Editor, Schizophrenia Digest

Some of the Some of the QuestionersQuestioners in in Marin County: Marin County:

• Lou Anne Sweaney, FNP, CMH • Richard Glass, MD, CMH• Karen Balsamico, Mental Health Consumer• Evelyn Castillo, MPH, BACR• Amy Rogers, OTR/L, Linda Reed Day Services• Alan Jamison, Program Director, Canyon Manor

Mental Health & Tobacco Mental Health & Tobacco Cessation Working GroupCessation Working Group

• BACR Tobacco Program Staff • Directors of Community Mental Health Services • Nurses…Physicians…Psychiatrists • Mental Health Agencies• Consumer Advocates• Peer Counselors• Case Managers

The Challenge: The Challenge: AskAsk

Linda Reed Day Services Survey*

• N=47• 72% smoke currently (average: 17 cpd)• 88% of smokers have attempted to quit• 88% perceive negative health effects • 65% have a desire to quit within the year

* Unpublished survey conducted by Amy Rogers, OTR/L, Linda Reed Day Services, 2004.

Linda Reed Day ServicesLinda Reed Day Services

• BACR staff/client trainings• ‘Quitters’ Club’• ‘Smoking Area’ Committee • 2 peer-led quit groups added• Quit group institutionalized as part of

recovery and socialization programs

Canyon ManorCanyon Manor

• BACR staff/patient trainings• Positive patient feedback• ‘No Smoking’ area created – The Gazebo• Nicotine patch program developed• Tobacco cessation program expands to

staff

Lessons Learned:Lessons Learned:

• Mental health clients DO want to quit smoking!• Harm reduction can be a goal• Multi-disciplinary support for individuals * Keep attending physician/psychiatrist updated on cessation progress and NRT use • Working group facilitates resource-sharing * It’s O.K. to say, “I don’t know, but I’ll find out.”

Why Integrate Tobacco Cessation Why Integrate Tobacco Cessation and Mental Health Services?and Mental Health Services?

• Smokers suffering from mental illness account for nearly half (44.3%) of all cigarettes consumed in America. Adler, Olincy, et al. Schizophrenia Bulletin 24:196. 1998

• The death rate among young adults with mental illness is more than triple that of their peers. Department of Mental Health, Massachusetts, 2001.

Why……?Why……?

• 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.

• Nicotine 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

Why not…?Why not…?

• Comparative smoking cessation rates• Smokers with any history of mental illness

37.1%• Smokers with past-month mental illness

30.5%• Smokers with no history of mental illness

42.5%

Persons with mental illness are about twice as likely to smoke as other people but have substantial quit rates.

Lasser, K., et al. JAMA 284:2606-2610, November 2000

Contact InformationContact Information

Beth Lillard Marin Tobacco Cessation Project Director

Bay Area Community Resources(415) 444-5580 ext 334

blillard@bacr.org