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RESEARCH WEEKLY: When Tackling the Toughest Challenge is the Only Option
Individuals with severe mental illness smoke cigarettes at rates twice as high as
the general population, greatly contributing to the 25-year difference in life expectancy
for this population. However, smoking cessation programs often exclude these individuals,
in part because of the difficulties associated with providing such treatment.
Clinicians at a safety-net hospital in California, Zuckerberg San Francisco General
Hospital (ZSFG), found there were enormous inequities in services

provided to those in inpatient psychiatric units versus other patients in the hospital.
Almost all patients on inpatient units who were smokers received smoking cessation
treatment or counselling by a dedicated team of licensed vocational nurses. However,
on the inpatient psychiatric units, less than 10% of smokers received such treatment
and there were no dedicated teams of professionals. The clinicians decided that
tackling the toughest challenge is the only option, publishing evidence of their
success in this month's Psychiatric Services.
The authors encountered many challenges in trying to implement this program. They
initially approached the dedicated smoking cessation teams on the other medical
and surgical inpatient units to expand the program to the psychiatric units. However,
the staff were resistant and said they were not prepared to work with patients on
a locked psychiatric unit.
Instead, the study authors decided to create an independent smoking cessation program
for the psychiatric unit, utilizing the clinicians already on staff in the unit.
However, a survey of the inpatient psychiatric providers revealed most did not
believe smoking cessation treatment was a worthwhile part of their practice and
had low confidence in the success of a program, commenting things like: "there are
other priorities to address on an inpatient psychiatry unit like substance abuse
counseling and reducing self-harm behaviors and psychotic symptoms."
However, the clinicians pressed on in their efforts. They developed a flow-chart
system to identify, prioritize and track patients on the psychiatric unit. This
allowed the providers to revisit a patient throughout their hospitalization as
their psychiatric symptoms decreased and they may be more amenable to smoking cessation
treatment. The authors also provided educational sessions to providers on the efficacy
and importance of smoking cessation treatments for these patients.
After four months of initiating the program, more than 80% of patients on the psychiatric
unit received smoking cessation treatment, a significant increase to the 10% of
people who had received it prior. Importantly, after the implementation, most providers
believed the smoking cessation treatment was a worthwhile part of their practice.
The results reveal the importance of prioritizing treatments for the most vulnerable
of individuals and not accepting challenges and difficulties as an excuse of passing
these individuals by. With more of this type of effort, we may be able to make a
difference in the major inequities in life expectancy and quality of life for people
with severe mental illness.
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Elizabeth Sinclair Hancq
Director of Research
Treatment Advocacy Center
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References:

*
Holler, J. T., et al. (2019, December). Smoking cessation counselling on inpatient
psychiatric units [[link removed]].
Psychiatric Services.
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Questions? Contact us at [email protected] [mailto:[email protected]]
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Research Weekly is a summary published as a public service of the Treatment Advocacy
Center and does not necessarily reflect the findings or positions of the organization
or its staff. Full access to research summarized may require a fee or paid subscription
to the publications.
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The Treatment Advocacy Center does not solicit or accept funds from pharmaceutical
companies.
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