smoking and mental health hertfordshire context

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    Leadership and Clear Priorities: The Hertfordshire ContextSmoking Cessation and Mental Health: Implementing NICE Guidance PH48

    Jim McManus, Director of Public HealthLiz Fisher, Head of Provider Services, Tobacco Control Lead

    East of England Seminar, 24 March 2015

    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


    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....

  • Slide courtesy of Gay Sutherland

  • Slide courtesy of Gay Sutherland

  • Slide courtesy of Gay Sutherland

  • Slide courtesy of Gay Sutherland

  • Slide courtesy of Gay Sutherland


    Herts smoking attributable morbidity and mortality


    Herts smoking prevalence 2010-2013


    Herts routine and manual prevalence


    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 healthMyths: Stopping smoking has adverse effects on mental health Mental health service users have other priorities Mental health service users dont want to stop smoking Mental health service users cant stop smoking


    Reducing the harm from tobacco - HWbB and PH Priority


    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


    The Hertfordshire Context 2 Developing more specialist stop smoking

    services behavioural sciences training from

    motivational interviewing to sponsoring people to become Chartered Health Psychologists


    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


    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


    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


    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).


    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)


    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


    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


    PRIORITY Groups


    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


    Tobacco Pension Investments



    Hertfordshire Masterclass for Practitioners...

    Smoking and Mental Health MasterclassWednesday 29th April 2015

    And enormous thanks to Liz Fisher, my Tobacco Control Alliance including Joel

    Bonnet, and all our partners