Presenter: Louise Ross

Tobacco Treatment Specialist / Project Lead

Sydney Local Health District

Aim To enhance the capacity of carers to provide quit smoking

support

• Carers survey

• Carers resource development

• Carers education program

• Train-the-trainer program

Completion July 2018

Funding Cancer Institute of NSW

Ethics approved

Drug Health and Mental Health (Sydney LHD)

One Door Mental Health

Other project supporters:

• Mental Health, South East Sydney LHD

• Mental Health Carers NSW

• Carers NSW

• Flourish

• Headspace

• Someone actively caring for a person with

mental illness

• May be a family member, friend or someone

who has a significant role in the person’s life

• May not be living with the person

• The caring role may vary over time according

to the needs of the person and the carer

Consumer: someone living with mental illness

Research shows carer involvement improves:

• Consumer participation in treatment

• Psychological treatment outcomes

• Medication adherence

• Relapse rates through early identification1

State and national mental health policies recommend:

• Carer involvement in treatment programs1,2

• Health services provide carers with information and

education about treatment interventions1,2

Sources: NSW Department of Health, 20081, NSW Mental Health Commission, 20142,

General population 12.8%

People with mental illness 35% - 73%

Source: Greenlaugh et al, 2015

Compared to the general population, smokers with

mental illness:

• Smoke more heavily and are more nicotine dependent1,2

• Die approximately 25 years earlier than non-smokers3

• Are less likely to be offered professional quit smoking support1,2

• Are as ready to quit, but may find it more difficult1,2

Sources: Bowden et al, 20111, Lasser et al, 20112, Prochaska, JJ 20113

• People exposed to second-hand smoke have:

- Higher lung cancer risk1

- Almost the same heart disease risk as smokers1

Carers and other family members are at increased risk due to higher smoking levels

• Increased stress on carers due to ongoing nicotine withdrawal symptoms, e.g. agitation, tension, anxiety

• Increased financial stress due to the rising cost of tobacco

Source: Greenlaugh et al, 2015

Quitting with a mental illness can be more challenging for

consumers due to:

• Heavier smoking and higher nicotine dependence1,2,3

• Chronic stress1,2,3

• Fewer social supports / cognitive impairments4

• Fears that quitting will exacerbate mental illness5

Sources: Bowden et al, 20111, Piper et al, 20102, Lasser et al, 20113, Mendelsohn et al., 20134, Prochaska, JJ 20115

People living with mental illness:

• Can and do quit successfully1

• May have their medication reduced when they quit smoking2

• Are likely to experience reduced stress, anxiety and

depression and improved mood and quality of life when they

quit3

Sources: Prochaska, JJ 20101, NSW Ministry of Health, 20172, Taylor, et al 20143

To evaluate:

• The knowledge, skills and attitudes of carers around

smoking cessation

• Carer/consumer smoking rates and second-hand smoke

exposure

• Access to quit smoking support services

• The resource, education and support needs of carers

Online and paper based survey

Disseminated through:

• One Door Mental Health

• Sydney LHD Mental Health Services

• Mental Health, South East Sydney LHD

• Mental Health Carers NSW

• Carers NSW

• Flourish

• Headspace

Ongoing from January 2017 – May 2018

Carer Respondents = 94

• 64% aged over 50 years

• 72% born in Australia

• 81% speak English at home

• 46% completed tertiary studies

• 42% employed

• 37% on a pension/benefit

• 87% living with others

0

10

20

30

40

50

60

70

80

90

Currentsmoker

Ex-smoker Never smoked

Carer

Consumer

Carer reported smoking rates

0

10

20

30

40

50

60

70

80

90

% of smokers

Consumers

Carer reported triggers for consumers

Carers reported a high to very high level of

nicotine dependence among consumers they

provide care to:

• 77% smoke within 30mins of waking

• 58% smoke 20+cpd

Of the consumers who smoked, carers reported:

44% were smoking inside the home

62% were not planning on giving up

58% had a previous quit attempt

67% had used NRT, 20% Champix, 3% Zyban

49% had sought support through a GP

Survey question Carer survey response

Yes/Unsure

Quitting is too hard for consumers 67%

Smoking reduces stress for consumers 74%

Smoking improves mental health symptoms 51%

Quitting may harm mental health recovery 78%

Willing to provide quit smoking support 72%

but…

Concerned quitting will increase carer stress 47%

Interested in improving knowledge and skills 67%

• How to use quitting medications

• Do’s and don’ts of providing support

• Impact of smoking on medications

• How to increase motivation to quit

Resource development:

• Emphasise the benefits of quitting smoking for mental

health consumers

• Address carer misconceptions about quitting smoking

• Include information about recommended quit smoking

medications

• Include practical support tips and also strategies to

enhance motivation to quit

Develop a range of resources to upskill carers:

• Brochure / fact sheets (printed and online)

• Video (One Door and SLHD websites)

• Group education program run through One Door Mental

Health and SLHD

Train-the-trainer program for carer group facilitators

Surveys available in the foyer

or

Go to: https://www.surveymonkey.com/r/8BXWSTB

Ph: 9378 1306 louise.ross@sswahs.nsw.gov.au