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Rosemary Lamont RN M.Ed York Region Community and Health Services

Prevent More to Treat Less Conference Session # B14.3 June 4, 2014

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Tobacco-by the numbers People with serious mental health issues (SMHI)

3x more likely to smoke

25 years of life lost vs. general population with smoking as a major risk factor

44% of all cigarettes smoked Els C, Selby P. CAN-ADAPTT: The Canadian Action Network for the Advancement, Dissemination and Adoption of Practice-informed Tobacco Treatment Clinical Practice Guidelines [Internet]. Toronto, Canada: Centre for Addiction and Mental Health; 2011[updated 2012 March 30; cited 2014 May 20]. Available from: https://www.nicotinedependenceclinic.com/English/CANADAPTT/Guideline/Mental%20Health%20and%20Other%20Addictions/Background.aspx#_ftn7 Callahan et. al. Patterns of tobacco-related mortality among individuals diagnosed with schizophrenia, bipolar disorder, or depression. Journal of Psychiatric Research 48 Issue 1January 2014. Available from ScienceDirect:http://www.sciencedirect.com/science/article/pii/S0022395613003063 Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states PrevChronic Dis [serial online] 2006 Apr [cited 2014 May 20]. Available from: http://www.cdc.gov/pcd/issues/2006/apr/05_0180.htm.

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Background Public Health (PHU) received request from 2 mental

health agencies- clients were asking for help to quit Another agency had done client survey on addictions-

tobacco #1- contacted PHU Wellness program initiated at hospital outpatient unit Environmental scan revealed no community based

programs for people with SMHI Brought agencies’ together to discuss problem and

solutions

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Where we started

Galuzzi L, Namib Desert [image on the Internet]. 2004 July 19 [cited 2014 May 20]. Available from:

http://en.wikipedia.org/wiki/File:Thorn_Tree_Sossusvlei_Namib_Desert_Namibia_Luca_Galuzzi_2004a.JPG#filelinks

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Community of practice (CoP) Synergy working together

toward common goal Sharing of research,

knowledge, expertise and skills

Strategies for organizational change

Friendly competition Moral support

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Reaching out to providers Breaking down silos Speaking their mission Connecting the dots… Scope and skills Building on relationships Challenging myths

Mahalko D, Concrete Staves [image on the Internet]. 2009 June 14 [cited 2014 May 20]. Available from: http://en.wikipedia.org/wiki/File:Silo_-_height_extension_by_adding_hoops_and_staves.jpg

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Goals: accessibility, coordination, capacity building

Novak J, The Tridge, Michigan U.S.A. [image on the Internet]. 2006 June 20 [cited 2014 May 20]. Available from: http://en.wikipedia.org/wiki/File:Tridge-Midland-MI.jpg

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Model made for our region

Tobacco Addiction Recovery Program (TARP)- Created by Tobacco Addiction Recovery Team. St. Joseph’s Healthcare, Hamilton Ontario

TEACH

Nicotine replacement therapy (NRT)

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Case manager voices Evaluation of Training- what I learned… How to respond to clients in a positive way- even small

steps are good People with mental illness are able to quit smoking

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Community collaboration CoP members

Community pharmacist

Physician

Case manager Client

Public health role Outreach to partners and funders Facilitate Community of Practice Preparation support documents Training of case managers Consultation on best practices Evaluation tools and results Resources creation or purchasing

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Client participant voices 100% agreed that the group met all or most of their needs and they would recommend it to others The group helped me by… Working towards building confidence Encouragement to quit smoking from others Free NRT Hearing other’s successes Positive reinforcement/ misconceptions

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Challenges Maintaining momentum Funding- various sources, annual Competing agency priorities Scope of practice Staff turnover Timelines Partnership development Service interruption

Successes Our major mental health agencies’ and hospital staff now trained on tobacco management strategies

Varying agencies have taken lead on funding applications

CoP members are providing support and resources to new members agencies

Most important: groups are offered in various locations to clients of participating agencies

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Lessons learned

Engage senior management – tell client stories Increase awareness of issue with LHIN planners Policy development for organizational change Expand membership on Community of Practice Regular training of case managers, new staff Program evaluation, client feedback, successes

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Key messages Client driven- they are asking for help Sharing the work Integrating TM into daily practice Utilizing skills and scope of practice

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Implications Every location unique in assets and challenges Think beyond traditional mental health agencies Are there opportunities for regional/provincial CoP for

mental health and tobacco- strength in numbers More data on health of people with SMHI as related to

chronic disease risk factors Enhance engagement of primary care providers

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Where are we now?

Shankbone D, Jewish National Fund Trees, Negev Desert [image on the Internet]. 2009 March [cited 2014 May 20]. Available from: http://en.wikipedia.org/wiki/File:Jewish_National_Fund_trees_in_The_Negev.jpg

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Last word…from clients The program gave me incentive to quit for good The program works and without it I could not have

quit…and I know other sick people Due to circumstances… in my life I wasn’t ready to quit

but when I get to that point I’d…give the program another try