Breaking the link between tobacco and mental illness

Over 4 million Australians are living with a mental illness, of these, more than 2.4 million are also living with at least one physical health condition. One of the most prevalent is cancer. An estimated 90,200 Australians are living with both a mental illness and cancer.

Did you know the highest elevated risk for premature death of people living with mental illness is for prostate and breast cancer?

Cancer contributes to the gap in life expectancy between people living with a mental illness and other Australians. For example, people living with a severe mental illness die 10–15 years earlier. More than three-quarters of deaths in people living with a mental illness are caused by physical health conditions including cancer. The good news is that many of these early deaths can be prevented.

We know that living a healthy lifestyle can prevent at least a third of all cancers. We also know that tobacco smoking is the most common cause of cancer and is responsible for 1 in every 5 cancer deaths.

Smoking increases a person’s risk of developing up to 16 different types of cancers including lung, mouth (oral cavity), throat (pharynx), oesophagus, stomach, bowel, liver, pancreas, nasal cavity and sinuses, voice box (larynx), cervix, ovary, bladder, kidney, ureter and bone marrow (myeloid leukaemia).

Daily smokers are almost 3 times as likely to have been diagnosed or treated for a mental illness (29% compared with 12%). We also know that smoking prevalence tends to increase alongside the severity of the psychiatric disorder. One Australian study showed about 70% of people living with schizophrenia and bipolar disorder smoke.

Quitting smoking not only reduces a person’s risk of developing cancer and other physical health conditions, but it also improves mental health. This includes significantly reducing depression, anxiety and stress, improving mood and psychological quality of life, and reducing the risk of developing a psychotic illness.

Australian research shows that 59-70% of people, regardless of their circumstances, want to reduce and/or quit smoking. People living with a mental illness are just as likely to quit as the general population, and 47% have made at least one quit attempt in the last month. However, the main problem is that few receive best practice smoking cessation support.

The most effective way to quit smoking, for those with and without a mental illness, is a combination of behavioural intervention (either in person or via telephone), and pharmacotherapy (nicotine replacement and/or medication).

Cancer Councils across Australia are joining forces with the community services sector to ensure everyone is given the chance to improve their health and wellbeing by tackling tobacco and making smoking history. We work together to identify tailored solutions based on evidence for addressing smoking and integrate smoking cessation into the everyday care of services to ensure that service users have ongoing access to personalised, non-judgemental information and support to help them reduce and quit smoking, in an environment they trust.

We believe all lives are equal. Nobody should live in poverty, be socially excluded or die early because of tobacco. For more information that is relevant to your state or territory please contact your local Cancer Council.

Initiatives supporting quitting smoking

However, the main problem is that few receive best practice smoking cessation support.

The most effective way to quit smoking, for those with and without a mental illness, is a combination of behavioural interventions (either in person or via telephone), and pharmacotherapy (nicotine replacement and/or medication).

Two approaches working towards smoking cessation for people experiencing mental illness (and others) are the ‘Make Smoking History’ program, and the ‘Start the Conversation’ campaign.

Equally Well investigated these programs to find out more.

Making smoking history – leave no one behind

Make Smoking History Priority Settings Coordinator, Cancer Council Western Australia Lorena Chapman, says, “We believe all lives are equal. Nobody should live in poverty, be socially excluded or die early because of tobacco. People accessing community services, including mental health services, make up a large proportion of the 230,000 Western Australians who still smoke tobacco. By health and community services across Western Australia working together, we can improve the poorer health and wellbeing outcomes often experienced by people accessing community services – simply by improving people’s access to ongoing support to reduce and quit smoking.”

“We work together with the organisation to identify tailored, evidence-based solutions for addressing smoking and integrate smoking cessation into the everyday running of services. We want to ensure that their clients have ongoing access to personalised, non-judgemental information and support to help them reduce and quit smoking, in an environment they trust.”

Make Smoking History is a free program coordinated by Cancer Council Western Australia, provided to help services in Western Australia to identify tailored solutions for addressing smoking and, importantly, integrate it into the work they’re already doing. Services are guided through a Make Smoking History project, aiming to ensure people accessing services are routinely offered information and support to reduce and quit smoking.

All of the services involved in the program are working towards developing tailored organisational-wide strategies that are sustainable, will have a positive impact, and make help to reduce and quit smoking easy to access.

Lorena says, “By working with community services together we aim to make it as easy as possible for people to receive support to quit or reduce smoking. That means that the solutions organisations implement proactively offer support and do not expect that people will ask for it. We recognise that people may not want to reduce and quit smoking immediately, but at least they’ll know where they can get support when they’re ready.”

Start the Conversation

‘Start the Conversation’ turns the traditional approach to smoking cessation on its head, by emotionally compelling health professionals to have conversations with patients about their smoking rather than targeting the person who smokes. Start the Conversation complements existing smoking cessation strategies including those led by Quit Victoria.

Emma Dean, Acting Population Health and Health Promotion Coordinator, Lead Pharmacist Smokefree, within Alfred Health, has been instrumental in the Supporting Patients to be Smokefree initiative across Victorian health services, and tells us more about the ‘Start the Conversation’ campaign – a great example of a collaboration between government (Department of Health and Human Services Victoria), and a health service (Alfred Health).

Emma says “People with a mental health condition who smoke want to quit as much as the general population, but they often lack confidence in their ability to quit and so may be less likely to make a quit attempt. We know that advice from a health professional is one of the most effective ways to encourage people to quit: one in every 33 conversations will lead to a patient successfully quitting smoking.

So how do we empower our health professionals to have these conversations? Alfred Health starts by identifying the smoking-status of every single inpatient that comes into contact with one of its services.

From there, trained clinical pharmacists deliver a brief intervention and support patients to ‘Quit or Cope’ during their stay.

Emma says, “These conversations need to become business as usual, ideally within 30 minutes of arrival at the health service. Being a totally smoke-free health service means smoking isn’t possible for patients during their hospital stay so we offer to make them comfortable, and support them to ‘Quit or Cope’. Nicotine Replacement Therapy (NRT) and behavioural support are offered, in various formats, throughout the stay. Alfred Health is committed to totally smoke-free and aims to ensure supports are readily accessible to the patient such as access to withdrawal medication – facilitating nurse and pharmacist initiation of NRT and patients making a long-term quit attempt are offered follow-up support at discharge.”

“Alfred Health approaches smoking as a health issue, a clinical issue. We try to provide advice to quit that is relevant to patients right now. For example, if they have been listed for surgery, we link quitting smoking to a better recovery and reduced risk of infection. If they are admitted as a trauma patient, we discuss improved wound healing and being able to get out of hospital faster.”

“We want to support people who smoke by offering them the opportunity to quit. Not doing so just widens the gap of entrenched disadvantage even further. Health professional advice is the greatest trigger and it’s the offer of support that’s important.”

“The intent of the ‘Start The Conversation’ campaign is to ensure conversations happen systematically; every patient, every time. This approach aims to prevent judgement by health professionals and ensure equality of care for all people who smoke. A brief intervention takes just a few minutes, but it can make all the difference.”

Quit Victoria, Pharmaceutical Society of Australia (Victorian branch) together with Alfred Health also partner to provide best practice for smoking cessation education to community pharmacists, who have a critical role often interacting with people with chronic disease and mental illness.

The Start the Conversation website has videos, resources and more information.

To find out more about these programs and the services that are already implementing sustainable and impactful changes please visit the Make Smoking History website and the Start the Conversation website.

The ‘Start the Conversation’ initiative and the ‘Make Smoking History’ program, are great examples of the Equally Well objectives in action.