Bad Habit Goes Up in Smoke
Monday April 7, 2008
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Individuals with SMI or more than twice as likely to smoke than the general population.
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What We Learned
motivated to quit and have made quit attempts in the past.
• What those with SMI fear the most is that when they try to stop smoking, symptoms of their mental illness will reoccur.
(Through our work, we have found that withdrawal symptoms from cigarette smoking mimic some of the symptoms of mental illness.)
• Providing opportunities for a continuum of support, such as psycho education, peer support, and assistance with appropriate nicotine replacement therapy, significantly increases chances of
successfully quitting.
• A comprehensive program tailored to meet the special needs of individuals with SMI increases the likelihood of a successful
quit attempt.
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a private, not-for-profit rehabilitation agency in Ronkonkoma, N.Y., was awarded a two-year grant by the New York State Department of Health through its tobacco control program to develop, implement, and evaluate an intervention for addressing tobacco use in individuals with serious mental illness.
The initial step was to understand the culture of the organization and to design a program that could be incorporated easily into the philosophy and structure of Clubhouse. To be consistent with the philosophy of empowerment, the members of Clubhouse were partners in the development and implementation of the project. Establishing an atmosphere of trust and inclusion that was consistent with the program goals was imperative to achieve staff and member “buy in.” To accomplish this, a multidisciplinary team approach was used that included nursing, social work, and administrative staff.
individuals who wanted further support to stop smoking “graduated” into smoking cessation classes. In addition to psycho-educational classes, counseling was provided by the social worker and nurse practitioner, using client-centered motivational enhancement therapy. Peer counseling sessions were held three times a week, led by members who had been smoke-free for six months, which added another source of ongoing support.
The entire Clubhouse community developed Wellness Fairs, and eventually members of neighboring Mental Health Programs were invited to participate.
The wellness fair is now an annually scheduled activity that incorporates smoking cessation into the system of care.
Staff was trained to address tobacco use with each member at Clubhouse, and relate it to one of that patient’s treatment goals. It was hoped that this would ensure a shift to a culture of healthy living that would be sustainable long after the NYSDOH-supported project was completed.
Awareness of the dangers of smoking has become a part of all programs offered at Clubhouse of Suffolk. Smoking at Clubhouse has been transformed into a culture where members now have opportunities and ongoing support to replace cigarette smoking with healthy activities. As one member of Clubhouse said, “Just because I have a mental illness does not mean that I do not deserve to have good things happen to me.”
Nurses are in a unique position to support individuals with mental illness who wish to stop smoking and to let the community at large know that the activity of smoking can be replaced with truly transformative therapeutic relationships.
Mary O’Shaughnessy, NPP, PsyD, is an associate professor of nursing in the Division of Nursing at Molloy College, Rockville Centre, N.Y., and an NP in psychiatry, Clubhouse of Suffolk, Ronkonkoma, N.Y. Bernadette Cain, MBA, is training consultant and Tara Fredericks, MSW, is project coordinator, Clubhouse of Suffolk, Ronkonkoma, N.Y.
To comment, e-mail editorNY@nursingspectrum.com.
