The Five Year Forward View for Mental Health (2016) highlighted that people with mental health problems have poorer physical health than the general population and are often unable to access the physical healthcare they need, contributing to avoidable health inequalities. People with severe mental illness are particularly at risk and die on average 15-20 years earlier than the general population.
In England, smoking prevalence among the general population is 15.5%, however among people with serious mental illness smoking prevalence is 40.5%. Therefore action is needed to help close the health and wellbeing gap, the care and quality gap and the funding and efficiency gap, associated with smoking in community and inpatient mental health settings, and to address this unwarranted variation in care outcomes.
The Mental Health Five Year Forward View taskforce report called for all mental health trusts to be smoke free by 2018. In achieving this ambition, ‘smoke free’ includes the implementation of NICE guidance PH48 and PH45 to ensure access to a full range of evidence based treatment options to support quitting smoking temporary abstinence for patients and staff.
These approaches are further supported by the two Commissioning for Quality and Innovations (CQUINs) relating to smoking and mental health and the smoking and mental health intervention as part of the Sustainability and Transformation Plans (STPs).
The Care Quality Commission also published guidance for inspectors on implementing smoke free policies in January 2017.
Some mental health trusts have successfully developed smoke free policies, implemented engagement strategies, trained staff and worked with their pharmacy teams to go smoke free.
There is still considerable variation around smoke free status, although many organisations recognise the need for action and are planning to go smoke free.
Leading Change, Adding Value (LCAV) demonstrates how nursing midwifery and care staff contribute to reducing the 3 gaps in the Five Year Forward View by identifying unwarranted variation, leading change in practice and delivering better outcomes, experience and use of resources.
This piece of work led by Public Health England (PHE) is a key programme aligned to and demonstrating the principles of LCAV.
The smoking cessation work to support mental health inpatient units and facilities in the South of England to help close the three gaps and lead on reducing this unwarranted variation has been led by PHE, and the LCAV components advised under the leadership of the senior mental health nurse at NHS England.
This builds on resources developed by PHE and expertise from experts who have successfully implemented components of the NICE guidance.