Nurse-led support doubles smoking quit rate in mental health patients

More than 500 heavy smokers with serious mental health disorders took part in a national randomised controlled trial to test a bespoke smoking cessation programme.

“Smokers with severe mental illness have been ignored for far too long”

Ann McNeill

Findings published in The Lancet Psychiatry show those who benefited from the intervention were more than twice as likely to quit smoking after six months compared with people who received standard care.

Health service leaders have confirmed the study, led by the University of York’s Mental Health and Addiction Research Group, will inform plans to provide extra support to help people with mental illness stop smoking as set out in the NHS Long Term Plan for England.

While the number of people who smoke in the UK has fallen in recent years, smoking rates among those with mental health conditions remains high.

People with severe mental illnesses such as schizophrenia are three times more likely to smoke than the wider population, contributing to widening health inequalities.

The trial – known as SCIMITAR+ – saw 526 heavy smokers with severe mental disorders such as schizophrenia or bipolar disorder recruited through 16 primary care settings and 21 community-based mental health settings across the UK.

Roughly half were randomly assigned to the bespoke smoking cessation intervention while the rest received standard care.

The bespoke programme was delivered by trained “mental health smoking cessation practitioners” drawn from local NHS staff.

“The smoking cessation practitioners were generally experienced mental health nurses who worked in conjunction with the participant and the participant’s primary care physician or mental health specialist to provide an individually tailored smoking cessation service,” said the paper.

The smoking cessation practitioners provided behavioural support plus advice on nicotine replacement therapy and medication to help stop smoking, which could then be prescribed by their GP.

Participants were offered up to 12 individual face-to-face sessions in their home or at NHS premises lasting roughly half an hour.

The intervention was delivered according to best practice guidance developed by the National Centre for Smoking Cessation Training UK but was specially adapted for people with severe mental illness.

Adaptations included offering extended support and making several assessments before setting a “quit date”, using “cut down to quit” strategies, and providing extra face-to-face support after a failed attempt to quit or relapse.

Those who received standard care were offered access to local smoking cessation services open to all and not specifically designed for people with severe mental illnesses.

Organisations taking part in the trial included Cambridgeshire and Peterborough Foundation Trust where mental health nurses were trained to deliver the intervention to smokers with severe mental illness in their own homes.

“We worked with 23 people in the local community to test this targeted approach and learn how to improve support for smokers with mental illness,” explained community psychiatric nurse Julia Ferris who was the local lead for the study.

The study found the proportion of people who had quit smoking six months down the line was “significantly higher” among those who received tailored support.

In all, 14% who received the intervention had given up smoking at six months compared with 6% of those who received standard care.

The proportion of people who had quit at 12 months was also higher in the intervention group at 15% compared with 10% of those who got usual care. However, the difference was “non-significant”.

“This exciting new research will help inform our work to implement the NHS Long Term Plan”

Tim Kendall

“The incidence of quitting at six months shows that smoking cessation can be achieved but the waning effect means more effort is needed for sustained quitting,” said the paper.

Lead researcher Professor Simon Gilbody, from the University of York’s Department of Health Sciences and Hull York Medical School, said the results showed smokers with severe mental illness “can successfully quit when given the right support”.

“We hope our findings will mean that this specialist support is available to everyone who might benefit,” he added.

The NHS Long Term Plan published in January this year commits to developing a dedicated pathway of support to help long-term users of mental health services quit smoking.

Professor Tim Kendall, national clinical director for mental health at NHS England, said the study findings would influence that work.

“This exciting new research will help inform our work to implement the NHS Long Term Plan and deliver the best possible support for smokers with mental health conditions to quit,” he said.

“Narrowing the gap in life expectancy experienced by people with mental health conditions must be a priority for everyone working in the NHS and helping smokers to quit is a key route to achieving this,” he added.

The Mental Health and Smoking Partnership welcomed the study and said learning from it should be incorporated into routine practice.

Ann McNeill, who is co-chair of the partnership and professor of tobacco addiction at King’s College London, said it was high time action was taken to help some of the UK’s most vulnerable citizens quit smoking.

“Smokers with severe mental illness have been ignored for far too long – and it is fantastic to see that changing,” she said.

“We hope that NHS England will take these findings into account when implementing the ambition of the NHS Long Term Plan.”

She said it was vital support to stop smoking was available in the community as well as in hospitals and inpatient services.

“Most smokers with a mental health condition live in the community, meaning community and primary care services also need to step-up the support they’re providing if we’re to narrow the gap in life expectancy. SCIMITAR shows how this can be done effectively,” she said.