Desire to Quit Smoking in an Outpatient Population of Persons with Serious Mental Illness
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Research that has looked at mortality among persons with schizophrenia, bipolar disorder, and depression, estimates between 48 and 53% percent of deaths are due to tobacco-related conditions.1 High rates of smoking and nicotine dependence among persons with mental illness is well-established in the Address correspondence to Carol Carstens, PhD, Ohio Department of Mental Health & Addiction Services, 30 East Broad St., Ste. 835, Columbus, OH 43215, USA. Jessica Linley, PhD, Ohio Department of Mental Health & Addiction Services, Columbus, OH, USA.
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Journal of Behavioral Health Services & Research, 2020. 1–8. c 2020 National Council for Behavioral Health. DOI 10.1007/s11414-020-09698-1
Desire to Quit Smoking in an Outpatient Population of Persons
CARSTENS & LINLEY
literature.2, 3 Data from the 2017 National Survey on Drug Use and Health (NSDUH) indicates that about 32% of adults with any mental illness smoke, compared with 23% of adults without a disorder.4 Smoking rates are higher in clinical populations with SMI, where up to 53% of persons with serious mental illnesses (schizophrenia and bipolar disorder) are estimated to be smokers.5 Despite higher rates of smoking among persons with mental illnesses, motivation to quit in this population is similar to the general population of smokers.6 Nevertheless, smoking cessation rates in the USA have been significantly lower among persons with mental illnesses than among persons without a mental illness.7 Unique barriers to smoking cessation for persons with mental illness include concerns about symptom management and the ability of cessation services to handle mental health issues, while other barriers—such as lack of support from health professionals—are shared across vulnerable populations.8 Studies in the USA that have identified lack of support from health professionals as a barrier have largely focused on the role of mental health treatment providers.9,10 In some cases, patients fail to ask health professionals for assistance with cessation while professionals fail to initiate discussions about the desire to quit. Such failures are often associated with negative expectations among both providers and patients about the ability of persons with SMI to quit smoking. Behavioral health professionals in particular may not view tobacco cessation as a high priority issue, given competing clinical demands and limited funding for services. Advising patients to quit is among the most basic approaches to smoking cessation used by health care professionals, and there is evidence that the likelihood of cessation increases with even minimal advising.11,12 Indeed, advising is the second of the five smoking cessation activities recommended in the US Department of Health and Human Services clinical guideline, Treating Tobacco Use and Dependence, which promotes physician intervention activities in steps known as the five A’s (ask, advise, assess, assist, and arrange).13 Psychiatrists recruited in an Ohio study on the use of the 5 A’s at community mental health centers reported advising a
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