Two heads are better than one: Australian tobacco control experts’ and mental health change champions’ consensus on addressing the problem of high smoking rates among people with mental illness
Della Rowley A D , Sharon Lawn B and John Coveney CA Discipline of Public Health, Flinders University, Level 2 Health Sciences Building, Registry Road, Bedford Park, SA 5042, Australia.
B Department of Psychiatry, Flinders University, Room 4T306, Margaret Tobin Centre, Adelaide, SA 5001, Australia. Email: sharon.lawn@flinders.edu.au
C School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, SA, 5042, Australia. Email: john.coveney@flinders.edu.au
D Corresponding author. Email:dellarowley@bigpond.com
Australian Health Review 40(2) 155-162 https://doi.org/10.1071/AH15028
Submitted: 9 February 2015 Accepted: 17 July 2015 Published: 14 September 2015
Journal Compilation © AHHA 2016
Abstract
Objective The aims of the present study were to explore the beliefs of Australian experts in tobacco control and change champions working in mental health and tobacco cessation, and to identify measures for addressing the problem of high smoking rates for people with mental illness.
Methods Qualitative interviews were undertaken to explore participants’ views, and the Delphi technique was used to achieve consensus on ways in which the problem would be best addressed.
Results This consensus centred on the need for leadership within the mental health system. The problem was reconceptualised from being solely the responsibility of the mental health sector into an issue that requires the combined resources of a partnership and shared leadership between government and non-government services, public health leaders, policy makers and people with mental illness and their families.
Conclusions Collaboration would raise the priority of the issue, reduce the debilitating effect of stigma and discrimination within the mental health sector and would place smoking reduction firmly on the political and public agenda. A recovery-orientated focus would increase the skill base and be inclusive of workers, families and carers of people with mental illness who face smoking issues on a daily basis. Reconceptualising this as an issue that would benefit from cooperation and partnerships would disrupt the notion that the problem is solely the responsibility of the mental health sector.
What is known about the topic? Rates of smoking have remained high for people with mental illness despite population-wide public health strategies successfully reducing smoking rates in the general population. For people with mental illness, the benefits of quitting smoking for both their mental and physical health are overshadowed by concerns about the complexity of their needs. There is a lack of knowledge about how smoking cessation support can be improved to increase success rates in smokers with mental illness.
What does this paper add? The present study is the first to bring a cross-sector lens of public health and mental health ‘experts’ together to discuss the reasons for the high rates of smoking among people with mental illness and to obtain their shared agreement on solutions. This Australian-specific study analyses participants’ responses to the problem representation and reveals what the issue is considered to be, where action should occur and how the problem should be resolved.
What are the implications for practitioners? For the Australian context, there is a need for leadership and a consistent smoke-free message about the benefits of not smoking. Staff working in mental health require training in providing brief interventions, motivational interviewing and pharmacological support. Joining together as a partnership of government and non-government services, including public health leaders and policy makers, and involving people with mental illness and their families, would benefit all concerned.
References
[1] Royal College of Physicians, Royal College of Psychiatrists. Smoking and mental health: a joint report. Report CR 178. London: Royal College of Physicians and Royal College of Psychiatrists; 2013.[2] Chapman S. Public health advocacy and tobacco control: making smoking history. Oxford: Blackwell Publishing; 2007 .
[3] Kuehn B. Author insights: high smoking rates persist among those with mental illness. JAMA; 2014. Available at: http://newsatjama.jama.com/2014/01/07/author-insights-high-smoking-rates-persist-among-those-with-mental-illness/ [verified 24 May 2014].
[4] SANE Australia. Smoking and mental illness: SANE factsheet. 2012. Available at: http://www.sane.org/images/stories/information/factsheets/fs16_smoking.pdf [verified 12 nOVEMBER 2014].
[5] Australian Institute of Health and Welfare (AIHW). 2010 national drug strategy household survey report. Canberra: AIHW; 2011.
[6] Morgan V, Waterreus A, Jablensky A, Mackinnon A, McGrath JJ, Carr V, Bush R, Castle D, Cohen M, Harvey C, Galletly C, Stain HJ, Neil AL, McGorry P, Hocking B, Shah S, Saw S. People living with a psychotic illness 2010. Report on the second Australian national survey. Canberra: Department of Health and Ageing; 2011. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/717137A2F9B9FCC2CA257BF0001C118F/$File/psych10.pdf [verified 11 November 2014].
[7] Scollo M, Winstanley MH. Tobacco in Australia: facts and issues. Melbourne: Cancer Council Victoria; 2012. Available at: http://www.TobaccoInAustralia.org.au [verified 12 November 2014].
[8] National Preventative Health Taskforce. Australia: the healthiest country by 2020. Canberra: Commonwealth of Australia; 2008.
[9] Gelenberg AJ, de Leon J, Evins E, Parks J, Rigotti N. Smoking cessation in patients with psychiatric disorders. Prim Care Companion J Clin Psychiatry 2008; 10 52–8.
| 18311422PubMed |
[10] Prochaska JJ. Ten critical reasons for treating tobacco dependence in inpatient psychiatry. J Am. Psychiatr Nurs Assoc. 2010; 15 404–9.
| Ten critical reasons for treating tobacco dependence in inpatient psychiatry.Crossref | GoogleScholarGoogle Scholar |
[11] Prochaska JJ. Smoking and mental illness: breaking the link. N Engl J Med 2011; 365 196–8.
| Smoking and mental illness: breaking the link.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXptlGls7c%3D&md5=9f23de8c19fd9115b38ca040196eb896CAS | 21774707PubMed |
[12] Ashton M, Miller C, Bowden J, Bertossa S. People with mental illness can tackle smoking. Aust N Z J Psychiatry 2010; 44 1021–8.
| 21034185PubMed |
[13] Moeller-Saxone K. Cigarette smoking and interest in quitting among consumers at a psychiatric disability rehabilitation and support service in Victoria. Aust N Z J Public Health 2008; 32 479–81.
| Cigarette smoking and interest in quitting among consumers at a psychiatric disability rehabilitation and support service in Victoria.Crossref | GoogleScholarGoogle Scholar | 18959554PubMed |
[14] Australian National Preventative Health Agency. Smoking and disadvantage. Evidence brief. 2013. Available at: http://www.anpha.gov.au/internet/anpha/publishing.nsf/Content/667CA10FF85FD2CDCA257B8C0031F7D3/$File/Screen%20res-Smoking&Disad_ev%20brief.pdf [verified 7 September 2014].
[15] Ashton M, Rigby A, Galletly C. Evaluation of a community-based smoking cessation programme for people with severe mental illness. Tob Control 2013; 24 275–80.
| 24335478PubMed |
[16] Apollonio DE, Malone RE. Marketing to the marginalised: tobacco industry targeting of the homeless and mentally ill. Tob Control 2005; 14 409–15.
| Marketing to the marginalised: tobacco industry targeting of the homeless and mentally ill.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2MnjvV2nsA%3D%3D&md5=38967aa73c804f9360f16e85913dcca9CAS | 16319365PubMed |
[17] Scollo M, Siahpush M. Chapter 9: Smoking and social disadvantage. In: Tobacco in Australia: facts and issues. Melbourne: Cancer Council of Victoria; 2008.
[18] Williams JM, Ziedonis D. Addressing tobacco among individuals with a mental illness or an addiction. Addict Behav 2004; 29 1067–83.
| Addressing tobacco among individuals with a mental illness or an addiction.Crossref | GoogleScholarGoogle Scholar | 15236808PubMed |
[19] Allan J. Smoking: time for the mental health system to confront its own ambivalence. Australas Psychiatry 2013; 21 203–5.
| Smoking: time for the mental health system to confront its own ambivalence.Crossref | GoogleScholarGoogle Scholar | 23720462PubMed |
[20] Lawn S, Pols R. Smoking bans in psychiatric inpatient settings? A review of the research. Aust N Z J Psychiatry 2005; 39 866–85.
| Smoking bans in psychiatric inpatient settings? A review of the research.Crossref | GoogleScholarGoogle Scholar | 16168014PubMed |
[21] Lawn SJ. Systemic barriers to quitting smoking among institutionalised public mental health service populations: a comparison of two Australian sites. Int J Soc Psychiatry 2004; 50 204–15.
| Systemic barriers to quitting smoking among institutionalised public mental health service populations: a comparison of two Australian sites.Crossref | GoogleScholarGoogle Scholar | 15511114PubMed |
[22] Lawn SJ, Pols R, Barber J. Smoking and quitting: a qualitative study with community-living psychiatric clients. Soc Sci Med 2002; 54 93–104.
| Smoking and quitting: a qualitative study with community-living psychiatric clients.Crossref | GoogleScholarGoogle Scholar | 11820684PubMed |
[23] Khantzian EJ. The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. Am J Psychiatry 1985; 142 1259–64.
| The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL28%2FkvVamtA%3D%3D&md5=adc43848afbf5525fe5bc5c6671bbb31CAS | 3904487PubMed |
[24] McNeill A. Smoking and mental health: a review of the literature. London: SmokeFree London Programme. 2001. Available at: http://www.substance.org.au/imagesDB/wysiwyg/McNeill20200320Smoking20and20mental20health.pdf [verified 11 November 2014].
[25] Lasser K, Boyd J, Woolhandler S, Himmelstein D, McCormick D, Bor DH. Smoking and mental illness: a population-based prevalence study. JAMA 2000; 284 2606–10.
| Smoking and mental illness: a population-based prevalence study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M%2FktlGiuw%3D%3D&md5=f3fa0f3b6364ced40ba380e313c7bb36CAS | 11086367PubMed |
[26] Leonard S, Adler L, Benhammou K, Berger R, Breese C, Drebing C, Gault J, Lee MJ, Logel J, Olincy A, Ross RG, Stevens K, Sullivan B, Vianzon R, Virnich DE, Waldo M, Walton K, Freedman R. Smoking and mental illness. Pharmacol Biochem Behav 2001; 70 561–70.
| Smoking and mental illness.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD38XktFClsw%3D%3D&md5=d0fd295e0e8e64f9d036f699ea9f7902CAS | 11796154PubMed |
[27] de Leon J, Diaz FJ. Genetics of schizophrenia and smoking: an approach to studying their comorbidity based on epidemiological findings. Hum Genet 2012; 131 877–901.
| Genetics of schizophrenia and smoking: an approach to studying their comorbidity based on epidemiological findings.Crossref | GoogleScholarGoogle Scholar | 22190153PubMed |
[28] Ziedonis DM, Hitsman B, Beckham JC, Zvolensky M, Adler LE, Audrain-McGovern J, Breslau N, Brown RA, George TP, Williams J, Calhoun PS, Riley WT. Tobacco use and cessation in psychiatric disorders: National Institute of Mental Health report. Nicotine Tob Res 2008; 10 1691–715.
[29] Fu SS, McFall M, Saxon AJ, Beckham JC, Carmody TP, Baker DG, Joseph AM. Post-traumatic stress disorder and smoking: a systematic review. Nicotine Tob Res 2007; 9 1071–84.
| Post-traumatic stress disorder and smoking: a systematic review.Crossref | GoogleScholarGoogle Scholar | 17978982PubMed |
[30] Kumar R, editor. Research methodology, 2nd edn. Frenchs Forest, NSW: Pearson Education Australia; 2005.
[31] Popay J, Rogers A, Williams G. Rationale and standards for the systematic review of qualitative literature in health services research. Qual Health Res 1998; 8 341–51.
| Rationale and standards for the systematic review of qualitative literature in health services research.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1Mvhslymuw%3D%3D&md5=2126a23a623f92bfc3583351247ecce5CAS | 10558335PubMed |
[32] Onwuegbuzie AJ. Effect sizes in qualitative research: a prolegomenon Quality Quantity: Int J Methodology 2003; 37 393–409.
[33] Sarantakos S. Social research, 4th edn. Basingstoke: Palgrave MacMillan; 2013.
[34] Rogers EM. Diffusion of innovations, 5th edn. New York: The Free Press; 2003.
[35] Bacchi C. Analysing policy: what’s the problem represented to be? Sydney: Pearson; 2009.
[36] Bacchi C. Women, policy and politics; the construction of policy problems. London: Sage; 1999.
[37] Begley A, Coveney J. Wonder vitamin or mass medication? Media and academic representations of the folate fortification policy problem in Australia and New Zealand. Aust N Z J Public Health 2010; 34 466–71.
| Wonder vitamin or mass medication? Media and academic representations of the folate fortification policy problem in Australia and New Zealand.Crossref | GoogleScholarGoogle Scholar | 21040173PubMed |
[38] QSR International Pty Ltd. NVivo 10 qualitative data analysis software. Doncaster, Vic: QSR International Pty Ltd; 2012.
[39] Saldana J. The coding manual for qualitative researchers, 2nd edn. Sage: London; 2013.
[40] Grbich C. Qualitative data analysis: an introduction, 1st edn. Sage: London; 2007.
[41] Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci 2013; 15 398–405.
| Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study.Crossref | GoogleScholarGoogle Scholar | 23480423PubMed |
[42] Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004; 24 105–12.
| Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2c%2FmvVKquw%3D%3D&md5=d1101c1b613c5e4815dcc214de16b915CAS | 14769454PubMed |
[43] Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educ Inf 2004; 22 63–75.
[44] Linstone H, Turoff M, editors. The Delphi method: techniques and applications. Newark, NJ: Addison-Wesley; 1975.
[45] Cantrill JA, Sibbald B, Buetow S. The Delphi and nominal group techniques in health services research. Int J Pharm Pract 1996; 4 67–74.
| The Delphi and nominal group techniques in health services research.Crossref | GoogleScholarGoogle Scholar |
[46] Strauss H, Zeigler H. The Delphi technique and its uses in social science research. J Creat Behav 1975; 9 253–9.
| The Delphi technique and its uses in social science research.Crossref | GoogleScholarGoogle Scholar |
[47] Thornicroft G, Rose D, Kassam A, Sartorius N. Stigma: ignorance, prejudice or discrimination? Br J Psychiatry 2007; 190 192–3.
| Stigma: ignorance, prejudice or discrimination?Crossref | GoogleScholarGoogle Scholar | 17329736PubMed |
[48] Corrigan PW, Watson A, Miller F. Blame, shame, and contamination: the impact of mental illness and drug dependence stigma on family memebers. J Fam Psychol 2006; 20 239–46.
| Blame, shame, and contamination: the impact of mental illness and drug dependence stigma on family memebers.Crossref | GoogleScholarGoogle Scholar | 16756399PubMed |
[49] SANE Australia. A life without stigma: a SANE report. 2013. Available at: http://www.sane.org/images/stories/media/ALifeWithoutStigma_A_SANE_Report.pdf [verified 12 November 2014].
[50] Davidson L, Sells D, Songster S, O’Connell M. Qualitative studies of recovery: what can we learn from the person? In: Ralph R, Corrigan P, editors. Recovery in mental illness: broadening our understanding of wellness. Washington, DC: American Psychological Association; 2005; pp. 147–170.
[51] Health SA. Framework for recovery-oriented rehabilitation in mental health care 2012. Adelaide: Department of Health and Ageing; 2012.
[52] UK Department of Health. No health without mental health: a cross-government mental health outcomes strategy for people of all ages. London: UK Department of Health; 2011.
[53] Davidson L, O’Connell M, Tondora J, Styron T, Kangas K. The top ten concerns about recovery encountered in mental health system transformation. Psychiatr Serv 2006; 57 640–5.
| The top ten concerns about recovery encountered in mental health system transformation.Crossref | GoogleScholarGoogle Scholar | 16675756PubMed |
[54] Borg M, Davidson L. The nature of recovery as lived in everyday experience. J Ment Health 2008; 17 129–40.
| The nature of recovery as lived in everyday experience.Crossref | GoogleScholarGoogle Scholar |
[55] Rickwood D. Recovery in Australia: slowly but surely. Aust e-J Advance Ment Health 2004; 3 1–3.
[56] Kingdon J. Agenda, alternatives and public policies, 2nd edn. New York: Longman; 2003.
[57] Australian Institute of Health and Welfare. 2014 national drug strategy household survey report. Canberra: Australian Government; 2014. Available at: http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs/ [verified 20 July 2014].
