Towards a Smoke-Free NHS

Mary Yates, Nurse Consultant – Health MaryYatesPromotion & Wellbeing at South London and Maudsley NHS Foundation Trust, blogs about the issues surrounding smoking cessation, mental health, and how best to support people who want to quit.

London has achieved significant progress in driving down smoking rates, but with 18% of the capital’s population still smoking there is much more work to be done.  London’s health care staff must play their part by providing the encouragement and support for more smokers to quit. Recovery is not possible if smoking is not addressed and it is essential that tobacco dependence treatment is an integrated part of every care pathway.  

Seeing tobacco dependence as an urgent clinical condition that requires priority attention is the first step. For too long smoking has been seen as a lifestyle choice, contributing to a system that did not adequately understand or appreciate the plight of the smoker who through no fault of their own becomes trapped and controlled by the powerful addiction to nicotine.

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Around 42% of the tobacco that is smoked in London is by people with mental health problems and therefore targeted efforts must be made to ensure that the required attention is given to address the leading cause of premature mortality in this patient cohort. Moreover, with around 38% of acute hospital admissions attributed to managing disease caused by smoking it is vital that due care and attention is given to prevent this burden on our overstretched NHS.

Smokers want to quit

Traditionally mental health services have seen smoking as a part of the solution to help people who are anxious, depressed, upset, angry or distressed. In fact it became the ‘go to solution’ for almost all issues that arose. Research in South London and Maudsley NHS Foundation Trust established that 23% of the smokers there actually started when they were admitted to hospital. Creating a culture that facilitates the development of healthy behaviours is the right thing to do rather than undermining health. People with mental health problems generally know that smoking is harmful and they are just as likely to want to engage in a quit attempt. In fact when a group of smokers in South London and Maudsley were asked, 58% were keen to engage with this treatment.

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Successful tobacco dependence must be PROMPT, PLENTIFUL and PURPOSEFUL.  Nicotine withdrawal symptoms are pretty horrible. They include feeling dizzy, lightheaded, irritable, restless, having difficulty in concentrating, depressed mood, constipation, mouth ulcers, urges to smoke, and increased appetite. Since they start almost immediately after the last cigarette is stubbed out, it’s necessary to ensure nicotine replacement therapy (NRT) is readily available at the point of entry to all smoke-free health services. NRT patches definitely help take the edge off the craving but they can be compared to putting a sprinkler on a fire, not effective at extinguishing the fire and although helpful in cooling it down take several days to build up to full efficacy. This is why heavily dependent smokers (those who normally smoke around 20 per day) need at least one or two other NRT products simultaneously with the patch, in order to better manage the withdrawal. In addition to prompt and plentiful NRT, smokers need behavioural support to help address the social aspects of smoking, and to examine and plan for making the required changes to routine to adapt to being smoke-free. Smokers who have specialist support are four times more likely to succeed in quitting. Varenicline is a very effective treatment that should be considered for all smokers who are interested in quitting, even those with mental health problems. Support to quit by switching to e-cigarettes must also be encouraged, so that the transition away from harmful burnt tobacco can be achieved.

By taking the above approach we've been able to make South London and Maudsley a 100% smoke-free environment which has lead to positive outcomes for patients and staff.

To find out more about what we're doing to join up mental and physical healthcare visit our Mind and Body Programme page

Want to learn more about how you can help people to stop smoking? Complete our e-learning on giving brief advice on quiting smoking.

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