Webinar: Securing a smokefree future for mental health services
psychiatrist and i’m delighted to be chairing this webinar on securing a smoke-free future for mental health services so this webinar is being hosted by ash and the mental health and smoking partnership and the eventual focus on how we can build on the activity in the nhs long-term plan to secure a smoke-free future for mental health services so it’s been almost a decade since the royal college of physicians and the royal college of psychiatrists published a joint report which described the burden of disease caused by smoking among people with mental illness and call for change and it’s it’s still the biggest contributor to the physical health burden of those with severe mental illnesses so there’s now a much wider recognition within mental health services of the of the need to work towards a pro-smoking culture and one that promotes quitting smoking but there remains significant variation across the country and little has changed unfortunately in terms of the overall rate of smoking in the population that we care for i think the group in the population who have been has struggled have found it most challenging to quit uh smoking so the creation of a tobacco dependency treatment services service in mental health inpatients through the nhs long-term plan is an opportunity to transform the landscape of stop smoking support in mental health services however if this opportunity is to be seized trusts and integrated care systems they’re going to be so important in all of this need to get on the front foot and prioritize the implementation of this program and look beyond to those receiving care outside in the in-patient environment so it’s the whole patient-care pathway and there’s no time to waste with this as we all know today’s event is an opportunity to hear more about the rollout of the long-term plan tobacco dependency treatment in mental health inpatient settings and to reflect on how we can make the most of this new funding in the system so we’re going to hear from the leading experts on public health and mental health before hearing examples importantly from those delivering stop smoking support around the country and the perspectives of experts by experience who both used mental health services smoked and quit so the event will be followed as you will know by regional breakout sessions with phe’s uh nhs long-term plan regional leads so we’re delighted to have around 300 uh people from across the country registered for the event today so i think the we’ve got the slide up now on housekeeping so the meeting is being recorded and a recording of the event and the slides will be shared with all attendees after the event and upload it to the ash website so it’ll be available for you all there please can all panelists and attendees keep themselves muted and turn off their videos unless they’re presenting ash staff will mute anyone who is unmuted and not presenting the meeting will include time for questions so if you’ve got any questions please add those questions comments or discussion points to the meeting chat and we’ll try to answer as many as possible and colleagues from ash will collate the key questions into a q a document and that will be shared following the event so um the agenda got the agenda up there on the slide hopefully everybody’s received a copy of the agenda with the links to join the regional breakout sessions if you haven’t received a copy or have any other issues please post any issues in the chat or email admin at smokefreeaction.org dot uk we’ve got a really packed agenda it’s really great to see so many great uh speakers um so we won’t have time for a break unfortunately but if you if you need to nip off then um you can catch up uh on anything that you’ve missed by uh looking at the webinar recording so okay we need to um keep to time so we’ll move straight to our first speaker i’m going to hand over to professor ann mcneill of the national addiction center at king’s college london and co-chair of the mental health and smoking partnership and anne’s going to talk about why we need to address smoking now and over to you thank you very much adrian and good morning everyone i’m really delighted to be here and it’s so wonderful to see so many uh participants uh this morning so yeah so i’m just going to say a few words about why we need to address smoking now so next slide please so um as most people on this call will be familiar um smoking prevalence in the general population is around 14 percent but as you can see it increases steadily um and in a step-wise way with the severity of mental health conditions as you can see there the highest levels we’ve observed are amongst people who are misusing substances but of course there’s an overlap there also with mental health conditions uh next please and you can see there that that uh is mirrored by a difference in life expectancy among people with and without mental health conditions so about 15 years shorter life span for those with mental health conditions and research is accumulating and this is a paper we just published last week to show that the majority of that life expectancy gap is caused by smoking or playing a substantial role in it and it’s certainly the most modifiable risk factor which could extend uh the lifespan of people with mental health conditions next slide please but it’s not just the fact that lives are shorter it’s also that people are living in ill with ill health so for every person who dies from smoking another 30 are suffering a serious smoking related disease and it’s not just the burden on the nhs but it’s also the burden on the social care system so on average smokers report difficulty completing tasks some seven years earlier and receive care support some ten years earlier than never smokers on on average smokers and recent ex-smokers are receiving nearly four times as many hours of care as never smokers and then because people are living with ill health it means that it affects their employment so smokers are much less likely to be employed than never smokers next slide please and that and so it’s not just um about poor health but it’s also about poverty so uh tesla langley’s work um she’s estimated that the annual spend on tobacco by smokers with a mental health condition ranges from around twelve hundred pounds to two thousand two hundred pound per year she’s also estimated that around a million adults in the uk with a common mental disorder are living in poverty and they’re also current smokers but if we took into account that money that they’re spending on their tobacco that would mean that many hundreds of thousands more would be in poverty and just imagine if that money wasn’t being spent on tobacco but was being spent on something that could add value and quality to their to their lives instead next slide please so the government has set an ambitious target or an ambition for us to be smoke free by 20 30 so nine years time and by smoke free they mean five percent smoking prevalence so you can see from the blue line that even those without a mental uh among those without a mental health condition it’s going to be challenging to reach that target but look at the black line um you can see that for people with a mental health condition it’s going to be it’s going to take much longer to reach that goal so some 20 years later and and this is work done by uh debbie robson and seoul richardson um showing that we’re leaving some populations behind and so we really need to accelerate that rate of decline next slide please so many of us have been on this journey for um several decades actually i think the first paper i published was around the millennium um but i think the landmark report was when the royal college of psychiatrists came together with the royal college of physicians to publish the report smoking and mental health and i quote persistent high prevalence of smoking reflects a major failure of public health and clinical services to address the needs of a highly disadvantaged sector of society so it’s an indictment on people like me and people in public health and people on the front line clinical services that this problem persists so we really have to collectively do more and then ash led the stolen years report in 2016 which called for exactly the kind of program that we see in the nhs long-term plan so we’re we congratulate the fact that um that long-term plan came out and it included um steps to take to reduce this problem next slide please however there are some challenges and the first is training so this slide and it’s from a survey led by ash shows the proportion of psychiatrists who have never had or who can’t remember having training in the following areas of uh smoking cessation so a variety of areas of smoking cessation support and you can see that it varies between a third and nearly 80 percent of psychiatrists who couldn’t remember having training um or haven’t had training uh in these areas so we can’t really blame clinicians because if they’re not being trained and given the information they require then obviously they’re not going to know how best to help smokers to stop next slide please so the next challenge is the myth of low motivation a lot of research including research from our group has shown that smokers with mental health conditions are as keen to stop smoking as people without however um inpatient mental health professionals and community mental health professionals as you can see here um often believe that people with mental health conditions are not motivated to quit so if you look at the orange and the blue bars there you’ve got around a third to just under half uh believing that smokers with mental health conditions don’t want to stop which means that they’re less likely to intervene with them next slide please and then we’ve got the challenge of smoke-free policies despite the fact that we’ve had smoke-free mental health settings for over a decade um we still haven’t fully implemented them so this slide is from a survey carried out by ash in 2019 and from the surveyed trust so from the respondents you can see that um over half of the respondents said that in their trust staff were accompanying patients on smoking breaks at least once a day and that’s very sad because just imagine if that time was spent therapeutically with those patients instead of supporting them to smoke next slide please next slide please looks like it might have frozen if you could just go back a slide um please thank you uh yes that’s the one um so of course everything’s been exacerbated by covid19 and we heard reports that a lot of policies um weren’t being implemented or were being disrupted and that was particularly the case for smoke-free policies during coverage so that slide i just showed was from 2019 it’s likely to have got worse we we saw some evidence that some smokers with a mental health condition quit smoking with greater success during the pandemic which is great news but the majority didn’t and many others were increasing their consumption of tobacco relapsing or taking up smoking for the first time those data have come from a variety of surveys including yoga and the owl survey carried out by colleagues in the university of york so consequently the pandemic may be exacerbating the significant inequalities this group are already facing and unfortunately the pandemic also means that the long-term plan is behind schedule and our concern is that um it will be further deprioritized in the face of the current pressures with mental health service users again falling behind next slide please but even if we fully implement the nhs long-term plan it still wouldn’t be enough to reach those very challenging targets so we also need to have similar systems in community mental health services where of course a lot more people with mental health conditions are seen we also need much better primary care support so research i’ve been involved in has also shown that primary care professionals are less likely to intervene with smokers with mental health conditions than those without and then we really need to be giving smokers accurate advice about alternatives we can use the analogy of the dirty syringe the cigarette is like the dirty syringe it’s the worst way to be getting your nicotine fix and now we have a plethora of other nicotine delivery devices which are much cleaner and must let much less likely to kill and that includes e-cigarettes so again that comes back to an education and a training point of view we need health professionals to be giving accurate advice about switching if they can’t stop nicotine use altogether so finally next slide please i wanted to leave on a more positive note so you know if we can do this and i think collectively we can we can of course extend healthy life expectancy we can reduce the burden on the nhs and we can reduce the burden on social care we can reduce levels of poverty we can promote employment and importantly and i haven’t said this yet there is accumulating evidence that when people stop smoking their mental health improves whether or not they had a mental health condition to start off with and this evidence was summarized just recently in the cochrane review led by gemma taylor it will also reduce the level of some antipsychotic medications and finally in a paper published today by colleagues from the university of bristol which shows the interrelationship between smoking and the use of alcohol and illegal drugs if we can reduce smoking and improve treatment outcomes it’s likely to have an impact also on drug and alcohol use so lots of good reasons um to move ahead with this agenda so thank you very much i hope today collectively real advances will be made to tackle this preventable risk factor and improve the lives of people with mental health conditions thanks so much for listening thank you over to you adrian and thank you so much for that introductory talk i mean clearly um not really terribly pleasant really uh to to be looking at all of that and as you said we all have some responsibility for what’s happened but also more importantly for what will happen going forward but uh good to finish on that optimistic uh note that if the evidence is very clear that if we actually address this we can make a huge huge difference to people’s lives and actually that issue around poverty as well i think is really very well made so i think probably the the number one issue for the new office for health improvement and disparities what what could be um a higher uh priority than this so thank you uh and so i’m now going to pass over to tim kendall tim thank you so much for joining us tim of course is the national clinical director for mental health at nhse he’s going to talk about the rollout of the long term plan and the uh the quit smoking element of that but put it within the context of the wider physical health agenda so thanks tim just a note from our organizers uh they have been shut out from the the tech and so they can’t answer people’s questions on the chat so if you do need to contact any of them please email them at admin smokefreeaction.org dot uk that that email address is in the the invite so if you need to do that but do please put your questions in the chat and we’ll try to answer some of them after tim’s presentation tim over to you thank you adrian um and i i i should confess that that that um i i i wouldn’t say i’m a fake in in regard to smoking um but i don’t i have no particular expertise around the research around smoking and and smoking cessation um having said that i suppose i am a a sort of uh yeah a person with lived experience having smoked about 30 fangs a day up until 21 years ago when i realized that if i carried on uh that my youngest child would probably um be fatherless before she was 18. um so i’m very much in support of of the work that uh ann and others have done and uh i’m very keen that nhs england should play its part so what i’m going to do is give you a quick summary of what’s happened with the long term plan and the five year forward uh where we’re moving forward in particular around community mental health services and that a very important focus of that is the physical health of people uh with mental health problems um i personally work in my clinical work is in sheffield working with homeless people with mental health problems and smoking makes a really serious contribution to their premature mortality which is currently running at age 43 so you know whilst people with serious mental health problems men with schizophrenia for example dying currently around about 60 years old and women at 65 people who are on the street um are dying younger still okay so um here’s the long-term plan i won’t say too much about it we’re doing stuff uh focused around areas like community mental health um we’re growing further our um our services around women um in the perinatal period and for the children of those women with mental health problems we’re developing crisis services we’re further developing work around 1-1-1 as many people will know that iap services although we’ve had a bit of a hiccup with our app services they continue to grow now all of this is based on us achieving what i’m reasonably confident we will achieve which is getting an extra 2.3 billion pounds into frontline services per year by 2023-24 and i say i’m confident with the coveted pandemic and the pressures on the nhs um the truth is is that there are a lot of areas in the long term plan who may not achieve their ambitions or goals by 23 24 but at the moment i’m reasonably confident that mental health remains ring fenced next slide please uh it’s also worth saying that before the long term plan we had the five-year forward view for mental health which i can reliably say has increased in an extra billion pounds going into mental health services by 2021. so over the five-year period since i was appointed as national clinical director we have seen a one billion pound growth and what that’s gone into is uh talking therapies in primary care iaf services but it’s also gone into children’s services and that’s improving access to psychological treatments for kids it’s also led to us investing in a brand new mental health service in uh schools so uh many of you may know that during jeremy hunt’s reign as as the secretary of state for health he was the first secretary of state for health who took on mental health as part of his portfolio um and one of the things that we did with him then was to develop a new service for children in schools a new mental health service and that is well underway um and as you’ll see in this by 21 early 21 we were hitting 3000 schools across the country when that’s finished in 2027 um could be sooner but when that’s finished in 2027 that will have doubled the size of the cam’s workforce now during the pandemic we did do a few other things we set up some crisis lines which really do work if you go on to nhs dot uk backslash talk you will find that if you put your postcode in it will tell you your local crisis help line and when you phone that you will get through to people with expertise in mental health um and we are currently discussing with uh 999 whether or not we can’t get a warm transfer for those who don’t have a physical health problem so not poisoning not an overdose no no self-harm that those with mental health problems can’t be diverted to to these lines um but we’ll test that out first next slide please we got 500 million extra to respond to coved starting in april this year so that has given us a chance to accelerate the schools program um it’s given us a chance to increase uh access to iapped programs particularly for people with ptsd which has been on the rise um we’ve also been able to invest in the mental health of the nhs workforce and set up hubs around the country with that um and so on so and also we’re focusing quite a bit on enhancing discharge from acute services which have been under real stress during uh kobit and the number of kids with 12-hour weights whilst it’s not gone up um over the cobia period it’s become much more pressing because because ambulance and a e services have been under such stress next slide please now as i said a major focus for the long term plan is an investment into community mental health now um what that amounts to is by 2324 every pcn uh of some roughly size 50 000 population will have an extra million pounds to spend per year on uh community mental health services they’ll also have an extra 300 million so that’ll be sorry an extra 3 million for every pcn 300 million for for england um on crisis in the community so this is a really sizable investment 1.3 million per pcn so now is the time to do something unusual and exciting and innovative next slide please so this is what we’re focusing uh focusing on first of all is getting as close to primary care as possible and we want everyone to move all their community services uh towards primary care so that there is no longer a gap between primary and second care that will give us a chance to rather than spend so much time that we have been doing because we’ve been under resourced in bouncing people out of uh out of mental health services but instead to focus on those people who most need it people with psychosis people with personality disorder people with eating disorders people with rehab needs and a central focus of this but not the sole focus is to ensure that their physical health is supported and that they can get to work so we’re investing in individual placement and support but as you’ll see in the central bit of this we want to make sure that we get physical health checks and the proper and proportionate response to those physical health checks for at least 390 000 people more per year these numbers are sort of mind-boggling in a way next slide please so some of that has got to be focused on smoking and i’m afraid anna’s already told you most about this so i’ll go over it very quickly if you look at common mental health problems this is in the center of the slide you’ll see that about 34 of people with anxiety and depression uh 34 are smokers and that rises to about 46 when they’re living in uh poverty which is universal credit basically um uh people with serious mental health problems that that rises to 40 percent people with uh psychosis it’s probably up to 60 it’s higher than that when they have their first episode and people on mental health inpatient units we’re talking about 70 um and a big message here is one of the biggest if not the biggest modifiable factor that drives early death amongst people with serious mental health problems is smoking is the biggest single factor next slide please um and again i’m i’m afraid anne has already told you all about this so there’s no harm in repetition it always helps you learn um [Music] a third of adult tobacco consumption is by people with mental health problems i don’t know if anne did mention that but um that that’s a startling uh issue startling fact um but i think the biggest message here is that people with mental health problems respond to exactly the same interventions that anyone else will um so whether that’s pharmacological or behavioral um they uh and and that their response is just as good as anybody else’s and their wish to do so is also there um so i i i think you know we really do need to focus on helping people with mental health problems to stop smoking as best we can next slide please and i think this is the final one um again and and has mentioned you know we are aiming that everyone who’s admitted to hospital by 2324 will be offered an nhs funded tobacco dependence treatment service and a new universal smoking cessation offer will be available and that includes people in the community um and as i’ve said you know the the interventions that we offer are going to be just as effective for people with mental health problems um so and and so yeah when people come into mental health services whether that’s in the community or in uh in in patients we need to make it as standard that people get an offer uh for smoking cessation and as as as has already been said when you compare even vaping against cigarettes we’re talking about them causing about 1 20th of the level of harm as far as we can work out at the moment and other ones like patches or lozenges or whatever else these are even even lower still so that’s me done um thank you thank you adrian and can i say thanks to paul cillia lacourt who is actually leading all the smoking cessation stuff in mental health and i think he’s on this call so if people want to link up with this paul is available and i’m sure we’ll answer queries in the chat line if people want to happy to take any questions as well great thanks tim i think we’ve also got sanjay agrawal who is the national specialty advisor for tobacco addiction who’s joining us just for the uh for the chat uh sanjay if you’re there thanks sanjay that’s great good good to see you so we’ve got some questions and we just got about five minutes for these i’m going to combine some of them i mean it is pretty shocking and the evidence about the effectiveness of stopping smoking is is huge so a question from sarah harding i’m going to ask a couple together is what about the senior leadership of the nhs and their commitment to this she’s saying that that commitment often it isn’t the absolute priority there’s so many other things going on so what about that the the senior leadership here but also why do we think that given the evidence is so strong and the need is so great that it has we haven’t done better um from i’ll answer that one first if that’s okay sanjay but the um commitment from the top is absolute i’m i’m you know i’m an ex-smoker i’ve i’ve got that sort of uh drive behind it um i’m not joking i mean i i see so many people on the street uh smoking and dying from smoking um and you know across mental health we really do have to do something about it um you’re absolutely right adrian why have we not achieved more now um and i i do think that there has been a long history of us saying look smoking’s a small issue by comparison to schizophrenia and bipolar don’t worry about and i remember in my youth you know sitting you know talking to patients sharing a with them and you know this has got to change and i think there is a will for it now okay sanjay yes i’ll take the first bit first about senior leadership so sarah if you’re referring to let’s say trust executive support in mental health trust you are absolutely right and we need the message to trust direct level board members that this is a prevention program that’s being led by nhs england and they have to play their role in terms of sponsoring the services during the rollout phase in the next two years so i completely agree with you and i’m not sure that we had that in the past but now that this has been funded fully funded by the nhs there’s actually no reason for it not to be supported at a trust level i’m sure tim and his team will be um if you like spreading that message and the requirement frankly of engagement and part of the um work we’re doing getting assurance from ics ics’s is determining whether individual trust boards are have got a senior sponsor for this program so that’s the first part of the question sir i think the second part was why haven’t we done more was that was that right agent right yes that’s right okay so i think why have we done more in the past is a good question i suspect and having tried to lead this service in my locality in an acute hospital the answer was always money in the past but now for the first time ever we’re in a fantastic position where money has been committed to fund these services they’re not they’re not no longer a cinderella service do it if you can and you know this is now funded and it’s an expectation so i’m i’m really hoping that we make an impact now uh because we have the tools and the means to do so okay another uh question uh about what sort of an issue is this and the somebody comments that we should be more focusing on this as being a dependency issue rather than a physical health issue sanji do you want to comment on that so it is a dependency issue i mean tobacco use is an addiction so and actually that’s how we have framed it what we’ve not done uh which i think that probably the tobacco industry and others would like us to do is frame as a lifestyle issue because if you frame it as a lifestyle issue then uh healthcare professionals and others uh don’t feel that they can you know intervene but if you frame it as a dependency issue which it is um then you can do more about it um so that’s why it’s been framed as a dependency issue is that the question adrian sorry it is yes yeah i just that we we need to focus on it more as being a dependency issue rather than a physical uh health issue i think it’s really interesting this because if you go into the rather rare environments of of uh drug rehabilitation uh residential uh sites everybody smokes yeah they don’t they don’t take drugs but they smoke facts because that’s okay and that’s what will kill them and you think we really have to reframe this it is a dependency issue and it causes probably more harm than any other single dependency okay final questions and again i’m going to combine them question really from brian watts and from marie domain and that is do we need to focus more on staff as well as on patients and one of the specific questions is about the nhs supply chain to make the provision of e-cigarettes simpler do you want to comment on those focus on staff but the supply chain actually the question is about supply chain for e-cigarettes for staff can i say about staff in in mental health i think that the smoking cessation programs that we might offer on inpatient units or out in the community should include staff it should be staff and patients i mean i’m very aware that actually mental health nurses still smoke more than most other nurses as far as i’m aware and you know why don’t we do this together client come in there so actually as part of the nhs plan there is a staff offer and actually we fully expect all of the treatment services that are starting up to be able to support staff to quit um so that there shouldn’t be any issue with that with respect to staff in mental health particularly as tim said um i think historically um there has been a high uh prevalence of smoking among staff staff facilitating smoking breaks um and that’s the culture that we need to change and i think by having on-site tobacco dependency services with high visibility sponsorship by trust board level members we will start to change that culture and that’s one of the aims of this program is to change culture within mental health around smoking with respect to the um supply chain for e-cigarettes i mean every um every trust at the moment has a different way it gets its drugs e-cigarettes i think everybody probably on this call is aware that you know nice are probably likely to include e-cigarettes as a treatment for tobacco dependency to be offered alongside varenicline and nrt and those recommendations come out in november i think once we have those nice recommendations uh then then possibly uh we’ll be able to sort of think about how e-cigarettes are provided they are a consumer product though they’re not a medicinal product which therefore makes them sort of different to other drugs that we can supply through the nhs supply chain okay well thank you so much sanjay and tim uh that’s really good to hear your views and i think we all agree there’s much that needs to be done but there’s a real willingness to to address this and to meet those targets so thank you so much we’ll move on to our next speaker who is angela bartley angela is consultant in public health and deputy director of population health at east london nhs foundation trust and she’s going to give an update on the trust’s experience of being an early implementer for the uh for the long-term plan so over to you angela a big welcome to or all of our audience we’re well over 200 now so this shows how important this topic is so angela over to you you’re on mute angela great start thank you thanks adrian um as uh he mentioned i’m the consultant of public health and i’m based at east london nhs foundation trust which is a community trust mental health twist and we also have gp practices as well so it’s quite a large trust that covers east london and also parts of luton and bedfordshire as well so we were one of the early implementer sites for mental health next slide please so i thought i would just give you a really sort of overview of how we found it and our experience of it what we’ve done um and some of the learning that we’ve taken from it and i’d be really keen to to hear from others and to share that as well so and this is what we started off with working with with paul and his team so what you know it’s a long-term plan so we’ve been early implemented to look at kind of applying those ottawa model ideas around systematic identification administration of pharmacotherapy and to active smokers admitted this is for our mental health inpatients and it was for three borough inpatient units so one in new room in london one in tower hamlets in london and one in city and hackney in london as well so how do we kind of get that administration of pharmacotherapy nrt et cetera to our patients really quickly to help with uh with addiction to tobacco once they’ve become an inpatient and then long-term follow-up in the community so we received 140 k that was our allowance for for the year to spend and we also had additional support um with the program manager funding as well okay next slide please so um as a trust we are we’re very big on quality improvement so it’s a kind of methodology that we use across the whole trust when we’re looking at how to improve things and how to make changes so i was really keen that we started to look at smoking taking a quality improvement approach and there’s several reasons for this one it’s a it’s a tried methodology that you can kind of measure change with the other is this is how we look at all our other um issues within a trust so i wanted staff to start seeing tobacco is as serious as how do we look at violence reduction in wards how do we look at um you know any kind of medication issues there any changes that we do in the trust i wanted tobacco to be up there and we look at it in exactly the same way we do everything else because i think it’s it’s echoing what um the other sanjay and other speakers have said i came from an acute trust and moved moved to to elft and i think there’s there was a sense that tobacco wasn’t as serious that actually once in patients admitted into a psychiatric unit there’s so many other issues going on around stabilizing them etc etc that that isn’t the right place to manage tobacco and it was seen very much as if someone wanted to quit we had brilliant support we already had an inpatient stop smoking service funded by the trust but actually it was still seen as a lifestyle issue and i really wanted to start moving it to being as important as how we might look at that patient psychotic medication how we might manage their diabetes how we’re managing their smoking and it was up there as a priority that ran through the whole of their inpatient stay so we in part equality improvement approach you do data collection because as we know data is quite compelling and it stops a lot of discussion and arguments when you can present some hard data especially when it’s from your own your own wards so our impatience probably very similar to people on the call who are working in mental health ranged from 49 smoking prevalence in bedford to 57 in newman hackney so much higher than the general public and and uh another another and even lower socioeconomic groups in the communities mental health much higher smoking rates and a high proportion of our service users already received very brief advice when we looked at the data um but a much smaller proportion received referrals to ongoing services and there was big variation between our dep directorates and that’s something that with qi methodology it’s very interesting when you start talking about variation and unwarranted variation because it prompts a question and a conversation about why is there such a difference so our left-hand graph simply shows um our different directorates so bedford luton knew him tower hamlets etc the green line is the proportion of patients who are given brief advice while they were an inpatient and the orange line is those that were referred so big differences so what’s going on in bedford which much smaller gap compared to say tar hamlets and it starts to have that conversation with clinical teams and on the right we just simply we looked at hackney just as an example we looked at the patients we referred to our smoke free hackney service which is run by by the count funded by the local london borough of hackney and the blue line at the top is the general public so all referrals that went to smoke free hackney the orange line is referrals of our impatience so health patients so you can see it starts off with those patients and then there’s a much bigger drop in that orange line around patients who didn’t have the right contact details or didn’t pick up or didn’t contact the service so you can see that massive difference that massive unfairness in mental health patients receiving support in the community compared to the general public and as a system we’ve worked really well with our partners um across hackney and newman and tower hamlets and in bedford newton to see ourselves as one system so our system isn’t working what’s not working that mental health inpatients aren’t picking up the same level of support in the community and it’s that kind of approach that we need to start talking about and we use qi for next slide please this i won’t go into the details of it but it’s just a driver diagram that we use that’s very common in our trust when we start engaging we’ve engaged with lots of service users on this we’ve engaged with um staff and you start to come together with some of those data and you start talking about the data and you work together it’s kind of a methodology around what are the problems so what are we trying to achieve um what are we trying to obviously improve quit rates among our mental health service users and then what’s stopping that so what are the drivers we want to look at so better referral to community much more integrated system and you know support from community mental health peer support workers is a strong model in elft and it works for lots of other areas why aren’t we using it in smoking and again that point people have made around staff knowledge and skills and confidence in it secondary drivers around um this is just an example from hamlet’s but um around how we would look at improving some of those and the ones i picked out in orange were the two sort of big things that we’ve decided as a system so um what we’ve decided to do is use the money to employ stop smoking advisors in elft but with a really strong line that links them to the community service as well but as far as the patient is concerned they are part of their recovery journey they’re part of the same hand the same kind of um support you would get as an inpatient that takes you through to outpatient community mental health where someone might be talking to you about your medication about your housing they’re talking to you about your smoking so you’re not seen as being referred off to a service you’ve probably never heard of you don’t know where it is you don’t know anything about it so we know it’s quite a difficult time when people are discharged so how do we make that process easier and how does smoking become a core part of your recovery journey on a whole range of issues and then again using that peer support worker model that’s that’s really good at health so how do we use some of the money to tap into formal peer support where they can talk about other issues one of the strong things that came through from our service users was smoking is a way of reducing feeling isolated and definitely a way of getting more breaks as perceived as more outside breaks when you’re an inpatient but once you’re back at home you know smoking kind of filled the day so how do we link them to those other activities that we’re putting on for patients that to help you stop smoking as well so recycling clubs et cetera et cetera and we’ll trial and evaluate that um and the next slide please so this is just our pathway and this is what we’ve broken it down for for staff and the green box again is that it’s seen as just post discharge support it’s not an onward referral to the community services will and behind the scenes ensure that smoke-free hackney and others have that data and are working with it and then they can we can work together and share the outcomes but the stop smoking advisor is seen as part of your elft mental health team okay last slide please so what’s been our learning on this journey so engagement of clinical teams uh we we tried we tried and started this and we tried it and started it again and during pandemics so there’s lots of stop starts lots of loads of work and then back to kind of crisis mode where generally clinical staff did not have the time to um really focus on smoking um and myself as a public health person was pulled away quite a bit into into covered response also we still have from senior staff right through about whether the inpatient environment is the right place to quit smoking so we’re still having that debate as well and you have to listen to people you have to take them on that journey with you data flow and as a public health person you probably guess i’m going to say this we’ve had to really rethink our whole data process where it goes to who looks at it where we’re analyzing it is it consistent etc to really understand that pathway around um you know ask advise assist and to really implement the ottawa model um evidence of effectiveness so again a lot of questions around does the ottawa model work in a mental health in patient setting you know how can we make it work there um and then again using qri methodologies really helped and then the last bit around logistics so um the the new money is fantastic and it’s a real shot in the arm and it definitely has raised the profile but it’s it’s not a huge amount and when you’re trying to employ staff in inner london um you know doesn’t give you loads and loads of staff everywhere and there’s been some stops starting with the funding and and i know paul’s worked really hard in his team but not being able to confirm longer term funding for certain things so that’s just meant a little bit of issues that always happens and then there’s been a bit of debate around the kpis that were set for mental health as well and can we shift them and i guess a big push from me around the importance of e-cigarettes as well as taking a harm reduction approach as well as encouraging quick being our first gold standard but the use of e-cigarettes as being part of that would be really helpful um and i know we’re waiting for nice but furniture england is quite encouraging for sanjay to say that’s what we’re um hoping will come out because i think for us it’s certainly a method of of harm reduction that a lot more of our service users are keen to support and i know our community partners would be keen if that became um a measure of success as well as absolute quit so that’s all from me and i’m happy to take any questions at the end or whenever is most useful great well thanks so much angela really good to see that the all the issues broken down with that uh driver diagram but also to see that learning so thank you so much for sharing that with us and uh do keep the questions coming in by email if you can i think some people the chat’s working some not technology off don’t you just love it and uh so we’ll move on to our next uh speaker um who is lisa evans uh lisa works for smoke-free uh smoke-free lead at nottingham sheer healthcare nhs foundation trust and she’s going to uh tell us all about what they’ve done in relation to training so lisa over to you thanks for joining us hello then good morning to all my colleagues who are listening this morning um yes so my name’s lisa evans and i’m um the smoke free lead for nottinghamshire healthcare nhs foundation trust a while ago we had an overhaul of our training that we provide we looked at who we provide training to what training we deliver and how as in what platform we use next slide please so one on the back of this we then adopted a multi-faceted approach to training we look we then worked it into different strands and then from those strands looked at what we can do to maximize the benefits and potential for staff and patients we now deliver training to staff who work on wards staff who have interactions with patients in other areas or in patients the community staff and all of the trust staff next slide please so for ward staff we deliver to traditional very brief advice nicotine prescribing guidelines and we do obviously deliver as well and present at the trust induction and i have the e-learning but then what we wanted to do was look okay let’s see what speciality modules we can deliver to make this more relevant so as well as the e-cigarettes and structured sessions during handover we also then started to deliver speciality modules including maternal health and smoking cannabis and tobacco mambo mamba crack cocaine and tobacco and then we actually coined the phrase that if you can smoke it we’ll teach it and use as well obviously the opportunistic mechs so making every contact count on top of that and what we’ve learned during covid as i’m sure a lot of other people here have as well is that by using other platforms such as teams we’ve been able to reach a larger target audience especially with the doctors so that once a month when they’re having their meetings we will actually go in and deliver more training as well next slide please one of the big things that we’ve implemented is a different type of training for our in-patients so we now deliver training during the wards community meetings for patients so for example if you’ve got a patient who’s come in during the night they’ve been admitted the reality is yeah we will ascertain if they’ve been if they’re a smoker within 20 minutes but in the middle of the night they’ll probably be given an inhalator or a patch slapped on them but there’s a potential that that patient doesn’t actually know what the nrt does how to use it effectively and could potentially if they’re not using it effectively still being nicotine withdrawal so our mental health and smoking specialist goes on to the wards during community meeting and discusses with the patients um the health benefits of stopping smoking addiction and gets out all the difference nrt and shows the patients how to use it by doing this we’ve actually had some really good um quit attempts from our inpatients who’ve actually shown much more of an interest and also we now co-deliver substance misuse and addiction sessions on wards with our external drug and alcohol partners as well and again like sanjay was saying earlier by treating smoking as an addiction and not just as a lifestyle choice this has had a massive effect and again a lot of interest from staff and patients next slide please so other staff who we have interactions with um are the reception staff at our local mental health sites um our outpatient services and in the patient shops so for example we know and i’m sure we can all say this hand on hearts that there’s a potential for our patients to not engage particularly well with the cpn when they come to their appointments for the medication for example but they’ll have a good old chin mag with a receptionist so what we’ve done is we’ve trained up all our receptionists and very brief advice and they’ll shortly have availability of e-cigarettes there for um patients to trial so we’ve got fred who’s about to go outside for a cigarette while they’re waiting for their appointments what we’re looking at is reception staff so tell you what fred it’s raining out there why don’t you try one of these instead next slide please and then community staff training is being delivered for all our community staff we are a diverse trust so as along with the mental health we also have physical health as well so we did we have delivered training through our health improvement workers which now mirrors the greater manchester maternity model for all our community mental health patients and staff so if you’ve got a patient in the home who wants to stop smoking and they’ve had that conversation rather than just hand them a leaflet saying yeah this is the phone number for your local stop smoking service we now make that appointment some referral whilst we’re in the patient homes and the require the referral rates have gone up dramatically since we’ve done this and we are also now delivering training across all specialties so including um one of the big ones that we’ve done recently are the prisons and also our respiratory um team as well next slide please never miss a golden opportunity so we link in um with the trust health and well-being events calendar and also annual health camp campaigns for example next month in november is oral health promotion month so we’re also linking with them and we have stands and um get that smoke free message out there we sponsor our local mental health football team which are in the um local football team mental health league so we’ve got smoke free logo emblazoned on their um kits i’ve got the list of the picture fixtures so at heart at half time our smoke free team will be down there and delivering opportunistic interventions to our patients um to try and get those quit turned around as well and using social media um nikki one of my members of staff is the queen of twitter and facebook and uh she is tasked with updating our um social media on a daily basis and we’ve got quite a good following now on there and all our training is advertised on there and any smoke free campaigns for example stoptober and that’s worked really really well because from that we’ve also had um staff engaging with us as well asking to stop smoking and we’re now able to support and signpost stuff as well next slide please so good external relationships is key i think too and works hand in hand with our training so we do a lot of work with our local stop smoking services i sit on the nottingham city stakeholder group for tobacco control with our other icp and ics partners and look at good sustainable exit routes post discharge but also what we’re looking at as well is different ways to think outside the box to engage our patients and and other ways to deliver our training as well and this works really really well next slide please so going forward so um we heard about and read with interest the ash report and stonewall report on the lgbtq plus community and the highest smoking prevalence in comparison to the general population and on the back of that we are actually um delivering a webinar on addressing these inequalities on the 2nd of february if anyone wants to join us please get in touch the other thing we’re doing which sounds a bit gimmicky but bear with us is called cup date so the theory behind this is grab a copper click on a module actually all be uploaded onto youtube they’re going to be short sharp and to the point so that for staff who have not got a huge amount of time but do want some advice on for example addiction and smoking they will actually be able to do that and the other one is on substance misuse tobacco and addiction we’re doing an awful lot of work with the prisons on this as well going forward and also we’re just in the pipeline now looking at prevention for our cam’s um cohort as well thank you happy to deliver um and answer any questions later on well lisa that’s absolutely fantastic i love the innovation around the training and the never miss an opportunity mantra that’s something we we all must take away from this webinar so thank you so much there’ll be a q a later on i hope you’re able to join us with that we’ll now move on to our experts by experience and i’m delighted to introduce hannah moore hannah works both with the royal college of psychiatrists and rethink and she’s going to talk about her own experience of smoking and interaction with mental health services so uh hannah over to you am i off mute uh you are we could hear you loud and clear brilliant okay so i’m going to give you a brief kind of background information about me throughout my story so i first entered the community mental health system at the age of eight and then was treated in the community and obviously at the age of eight i wasn’t smoking um eventually three days after my 14th birthday i was admitted to my first psychiatric hospital and this is where i stayed for just under a year i did smoke then and i actually increased my smoking dramatically because everyone else was doing it after that i was in and out of child psychiatric hospitals therapeutic communities children’s homes and also an admission to an ad award when i was 15 years old when i turned 18 i was transferred to the adult team and adult hospitals i was a result revolving door patient for a long time and i was becoming more and more unwell and arrested to myself so i was admitted to a pq my wrist had spiraled out of control and even at the pq i was still managing to hurt myself so i was transferred to a secure hospital in my 20s and this is where i stayed for nearly five years and since coming out six years ago i’ve been very well with just the odd little blip but managing in the community with a couple of short admissions where i was given ect and then back in the community quite quickly for for all of these admissions i went into hospital as a smoker i started smoking about 11 12 years old i was already quite unwell and you smoking is almost a relief from my mental pain i was suffering a distraction but also a way of being defiant and if i’m honest trying to look a little bit cool i had my first cigarette when i went to the shop with my older sister and i guess it was downhill from then at this time i was studying classical singing and was regularly entered into competitions where i spent years winning my categories but some all smoking did was make my voice weaker and it showed in in where i placed opera takes a lot of breath control and when you’re smoking probably about five a day when i started it it was it was it wasn’t enough but it was enough to not have the breath control i needed anymore when i first got admitted to a child psych hospital i just turned 14 a couple of days before when i got there i was shocked to see that all of the other kids on the ward smoked and there was even a little garden with within the ward that was used as a smoking area and this wouldn’t happen now but this is where my smoking increased considerably and when from about five a day to probably around 20 a day this was also the case in my children’s homes secure children’s homes and therapeutic community when my local trust became completely smoke free it was such kick in the face because personally i know others did too use smoking as a coping mechanism throughout all the non-smoking hospitals i went through even my secure unit i was never offered a personalized smoking cessation plan that was tailored to my needs all i was ever given was the little inhalators and my until my last admission i was told that i wouldn’t be able to get leave as i was on section three so they offered me patches gum inhalators and spray but it wasn’t monitored at all it just wasn’t and it was it was just here’s the patches and bits but no like follow-up or anything so there’s definitely a need for mental health staff to receive better smoking sensation training in order to better support service users i decided to go for the patches and then inhalators but of course if i could sneak a cigarette i would and yes i was one of those annoying patients that would set the smoke alarm off while smoking in the toilet and i apologize for that when i went back into the community i started smoking again even though i spent nearly five years not smoking in the secure hospital i did try and stay quick but i went into supported housing where like everyone smoked so in the end in a week or two i went back to smoking which i really regret and i smoked ever since there was about six weeks where i used patches and tried to stop with my chemist at my local pharmacy but then i started again i also tried to go cold turkey which didn’t work just over a year ago i suddenly had the urge to quit i don’t know why i just did maybe because i wasn’t enjoying it as much as i used to maybe because of covid or mainly i think the ridiculous amount of money that was costing me but i also did things differently this time i did it for myself and not because my family or partner wanted me to um and that’s part of the reason why i think it worked this time i got help from a professional so my first step was a consultation with a smoking nurse and we discussed what was available and we decided to try the medication champix the first two weeks of taking the medication you can continue to smoke and it’s supposed to make you almost like go off smoking and i was really skeptical but honestly it’s the best thing i ever did as it really worked and by the end of the two weeks i’d gone from 20 cigarettes a day to about three or four cigarettes a day one thing that i thought was really great and something that i never probably had in the past was that i was assigned a specific non-smoking nurse at my doctor’s surgery who spoke to me weekly first and then twice weekly she was available also if i had any questions and you could just ring the surgery to speak to her the only problem with champings with mental health is it comes with some nasty side effects especially if you have a mental illness for the first month or so i was fine but i can and as i continued to take it i was more and more depressed my voice is worse and i was having horrendous nightmares i wanted to continue even though the nurses expressed concern i agreed to half the dose but things didn’t improve so i had to stop it early as my mental health team was more even more concerned although it did affect my mental health for a short period of time i’m still so pleased that i’ve tried trampix as it was the only thing that has actually helped i can officially say that i’ve been smoke-free for just over a year now and i truly believe it’s one of the best things i’ve done and i’m so pleased i don’t smoke for many reasons so one i have much more money i was smoking 20 a day probably when i quit so that’s over 300 pound a month if smoking tailor-made cigarettes and not buying them in different countries when you go on holidays so number two my singing voice is better and this may seem silly for some anyone but it’s quite a big thing for me because it was my release i have a better range so i can hit the notes i’ve been able to not been able to hit for a long time still a long way to go i’m definitely improving so my family and my partner have always been really anti-smoking and regularly told me i stink and yes it was the smoke and not just me as they don’t tell me i stink don’t stink anymore um i don’t miss things like say i’m out or at home with friends or something i would go out for a cigarette and i’d come back and i would have missed half the conversation so as i mentioned before i didn’t have much help with quitting smoking until recently but when what i did get this last time was really helpful so yes i really think it would make such a difference to patients if staff are trained properly in the community but especially when patients are in hospital as going into hospital is hard as it is without quitting smoking there are some things that i think staff could do to help the patients who have had to quit who had to quit because of coming into hospital even if it’s just for a short while until they’re discharged no one can tell 100 if someone’s going to be in hospital a week or or whether they’re going to be there for years like i never went into my secure hospital thinking oh i’ll be here five years i thought they told me 18 months and i was like oh my god that’s ages um obviously you can’t tell so don’t assume that they don’t need help back in the community um soon as they will start smoking again so help them quit don’t expect that they won’t be there for very long so helping them quit is pointless because it’s not pointless and the more you say and do to help them the more likely they will stay quit so number one you need to constantly tell your patient they are doing well and that quitting is hard but they’re doing it tell them all the benefits as this will make them much more likely to stay quit once they’re in the community and have a choice about smoking if you have ingrained into them in all the benefits including money as that’s what kept me going um they will be much more likely to stay quit so number two i don’t think that oh they have mental health conditions so we can’t use shock tactics of course you can you can everyone you know you know danger of smoking doesn’t stop just because you have a mental illness patients should be taught about the risks number three be the one to initiate conversation regarding smoking when the patient is first admitted i can remember one time when i was in hospital it wasn’t until i saw another patient with one of those inhalators that i knew we could have them on the ward number four give the patient the option as to what kind of nicotine replacement therapy they would like or if they had anything in mind if they don’t recommend one number five it would help if you had a designated smoking nurse or support worker who has available patients to talk to and trained in the correct ways number six maybe have patients key workers embedded into care plans and make it something that will be talked about regularly every time you sit with your no nurse and number seven when someone hits a milestone this should be celebrated or at least acknowledged if i was an impatient again and i still smoked let’s hope that both of these things don’t happen but this is the kind of thing that i would have want done thank you wow well hannah thank you so much for sharing your your story and your journey the lots of comments in the chat uh how inspired that uh people have been and you know just fantastic well done you for for giving up and i think those you know top tips i think we i’m sure everybody’s been writing them down and perhaps we’ll come back to those in the q a so thank you so much and also lots of comments about the singing and maybe if we have time later on depending upon the q a um we might have a vote actually uh hannah’s singing or do we go for the q a but we’ll we’ll leave that to later on so thank you so much hannah really uh um really generous of you to share your story and your top tip so thank you okay let’s move on now to our next expert by experience and peer consultant kevin james uh he is working with rethink and he’s gonna tell us about his experience so kevin over to you you’re welcome thank you so yeah i want to draw my own lived experience of of the reasons why i started um smoking but but also um that the important work that i and other living experienced practitioners have been doing to try and help um enable the system to be more responsive and supportive of the needs of people with severe mental illness in in respect of trying to give up um and quit um tobacco um and i also co-chair our expert by experience group for equally well uk which is also about closing the mortality gap that exists for those of us with severe mental illness um alongside professor wendy burn who chairs our clinical working group um so for me um some of the reasons why i started smoking i grew up in a really chaotic violent fat family environment i i was experiencing abuse of all sorts from the age of six physical mental and verbal abuse and i started smoking and drinking and using substances like cannabis from the age of 10 and i was using those substances as a trading mechanism less about kind of peer pressure and peer support even though i started to become immersed in gang culture but most of the um the the the young people of my age were using substances for very similar reasons and and that addiction alongside others um carried on for 26 years um so it’s really important that we that we we speak about how how um smoking can be a gateway drug to other more harder substances another thing to consider as hannah touchdown is um tobacco-related poverty um you know significant increases in in the price of tobacco products year upon year upon year um which has led to tobacco poverty but also it’s led to people buying cheap counterfeit products which are you know carcinogenic really dangerous um one of the ways i got around that was that i i started making trips to the continent and buying um bulk buying tobacco products um and bringing them back into the uk and and and smoking those but also selling them on to friends and family and other people in my community and and was making money out of that so so that was another um kind of hook and a draw because because i was making money from it and being able to smoke cheaply um so i was enabling others really um some of the reasons i got into quitting smoking was that i’d lost a very close friend um a very young age because of smoking and alcohol-related disease watching someone lose their life quite quickly um was was harrowing and traumatizing and it led to me developing health anxiety and i really struggled with that and also i think what anne was saying before in her presentation is that you know people with smi people with mental health conditions equally want to give up smoking alongside other people who smoke in society and i think i think it’s important to to recognize that but it got to the point for me where the anxiety and the fear of developing disease and diseases attributed to smoking and drinking and others became more it more outweighed the addiction and the need to smoke um and also um when i gave up smoking which is 2006 um it was also the smoking ban had been coming it had public areas like pubs and i was a heavy drinker as well and i just kind of thought well you know now is maybe the time because you know we know that tobacco complements alcohol and alcohol complements tobacco in how they interact to substances and it seemed like a good opportunity you know i think again what hannah was speaking about in respect of being supportive and recognizing the challenges and how we need to support people to give up smoking you know is kind of like like any addiction it’s kind of like catching the crest of a wave you know you’ve got to keep trying and trying and trying and eventually hopefully you’ll be able to give up but but i guess what i wasn’t expecting as a result of giving up smoking and drinking and substances at the same time was that i would i lost my social um circle i lost my community because i stopped going into a pub um because i didn’t want to drink because i didn’t want to smoke i became quite quickly isolated and lost my friendship circles and and groups you know um and i found out i was that’s something i wasn’t expecting and i found really difficult um [Music] so also um [Music] you know i i did approach some smoking cessation groups um but actually i found them quite a new age really in how they went about you know providing that kind of that group environment and we weren’t allowed to talk about kind of like you know as hannah said shop tactics you know we weren’t allowed to talk about traumas of of losing loved ones who weren’t allowed to talk about the real reasons as to what was motivating us to want to quit quit smoking which i found really difficult really um so we couldn’t discuss those reasons i mean and i said like any other addiction it really is about keeping on trying and supporting people and being supportive and positive and enabling and saying well you know you haven’t been successful this time let’s let’s keep trying um it’s about making every contact count in respect of our approach and you know some interventions um you you know aren’t consistent so you know as an inpatient we do a lot around smoking cessation offering other um uh products patches you know e-cigarettes those kind of things but my experience is that that level of support and enablement doesn’t necessarily follow you into community mental health teams or into primary care and it tends to fall down and what we need is a consistent approach so it does need to be written into care plans as hannah has suggested um because we do need that you know part of a discharge plan is if you are discharged to community mental team who’s going to pick up um the smoking cessation part of your or if you’re you know if you’re um discharged back to your gp who’s going to continue on the support in the community because what i found is people tend to come out of hospital inpatient environments and then start smoking again and then go back in then into the cigarettes and patches and then back out again so that’s really unhelpful um and also i think it’s about how also you know when you’re an inpatient or or a community service user you know and you’re seeing staff smoke that’s a real kind of conundrum as well because you know whilst we’re focusing on smoke-free sites being free and the nhs saying we want to help you make healthier lifestyle choices we want to help you give up smoking i think we should be adopting the same approach for our staff members you know i also work in a mental health trust and you know and i only need to look out my window to see staff smoking on nhs premises and and people on impatient boards and garden areas can see other staff members smoking or staff members coming onto wards and smelling of smoke so we need to consider a consistent message for everybody and provide that same support for staff as we do um other you know and we also need to really empower staff to have difficult conversations because um you know it it can be seen you know staff avoidance is is part of this in respect of having difficult conversations um with service users about the reasons for quitting and the benefits of that but it can be avoided by staff because of fear of of conflict or breakdown in therapeutic relationships so again as hannah was saying it’s really important about the training and getting the training right and the messaging right and we really want to empower and support staff to do that um you know some of the benefits that that probably would have been useful for me to know at the time is azam was saying in her presentation about you can go on and reduce your medications you know psychotropical mood stabilizing medications by up to 50 um which is a real motivator because you know quite often a lot of those medications cause significant weight gain so it’s about explaining the message um and for me you know energy i had more energy you know i did i realized how much i smelled as a smoker when i was around other smokers but i’ve given up you know getting my sense of taste and smell improved in more energy we need to wrap up a bit uh okay and also i guess what i would say as a service user is that we don’t have confusing messages so you know what we’re saying to people is we want to help you smoke that could quit smoking and provide you with some mechanisms to help you do that but then if we’re serving people on inpatient wards pre-packed food that’s full of salt sugar and fat that isn’t good for a person’s health that can be a conflicting message and make it even more difficult to convince people that we do care about them for the right reasons and we want to enable them to give up smoking and make healthier lifestyle choices thank you for listening kevin thank you so much again for your generosity in sharing your own experience and reminding us of the importance of peer support um never give up trying um and making every contact count just a couple of points have been raised in the chat people have raised the issue of champix not being available at the moment ash have been in contact with fisa we don’t know when it will be available but there will be an update through the mental health and smoking network when we when we hear and people have asked for hannah’s seven top tips and we’re gonna pop pull those together and send those round so we’ll move on now to dr debbie robson debbie is senior research fellow at king’s college london and debbie you’re going to talk to us about the role of e-cigarettes so over to you debbie thank you good morning everybody and and thanks to hannah and kevin for sharing the challenges that they’ve overcome and what we need to do better so congratulations for such inspiring talks um so if i can get my presentation to me [Music] um so e-cigarettes can support smarter mental health services in several ways so the more popular uh have greater reach than nicotine replacement therapy and varenicline although nrt and varenicline as hannah said are effective e-cigarettes help people quit smoking or they can reduce withdrawal symptoms so if you’re an inpatient unit then you’re in less discomfort and it enables people to focus on their recovery they’re less harmful than smoking depending on the type of e-cigarettes allowed in inpatient services and the e-cigarette policy it can reduce fires but there’s still challenges to overcome so i’ll try and unpack the evidence base to support some of those statements so since 2013 in england e-cigarettes will be the most popular aid used in the quit attempt uh so in 2021 so these are from the general population from monthly household surveys that university college london colleagues do each month so the last data point in 2021 26 percent of people had used an e-cigarette in their most recent quit attempt compared to people uh four percent of people use champix or six percent of people who had nlt on prescription um their popularity peaked in 2016 and it’s been variable and s been in a slight decline ever since so they’re popular but do they help people stop smoking so university colleagues are the best people uh university college london colleagues are the best people to answer this question and what they did with their smoking toolkit data they looked at just under 19 000 people who’d made at least one quit attempt between 2006 and 18 and what they found was that quick rates for people who used e-cigarettes and people use varenicline were comparable for prescription nrt that that was still effective in 14 of people but just people under the age of 45 what didn’t increase the chance of quitting was nrt bottle with a counter so from you know your local boots or pharmacy as well as behavioral support on its own or telephone support or hypnotherapy vaping is much more common so earlier this year 26 compared to varenicline of about four percent using varenicline so vaping has a much far greater reach and therefore helps more people quit colleagues at cochrane so uh jamie hartman boys and colleagues they’ve been doing a living systematic review for uh just over a year now and their most recent review was published last week it included 61 studies with just under 17 000 participants and what they found was that e-cigarettes that contain nicotine are more effective than those that don’t contain nicotine and e-cigarettes that contain nicotine are more effective than prescribed nicotine replacement therapy and cochrane were moderately certain about this evidence nicotine e-cigarettes compared to behavioral support or no support is effective but there was a lot of high risk of bias in those studies common side effects reduced with continued use and the overall incidence of serious adverse effects was law but they did caveat that with saying that um the longest follow-up was two years and the number of studies was quite small we looked at the evidence base for e-cigarettes for smoking cessation in people who use mental health services from research trial data in our 2020 public health england report our ev our annual evidence review of e-cigarettes um no randomised control trials um and very small numbers you can see the sample sizes there so these are studies done in people with schizophrenia or bipolar disorder bipolar disorder or with a psychosis or the dual diagnosis they were largely conducted in people who were who were not motivated to quit or didn’t intend to immediately quit because the studies go back to 2013 um a lot of these uh e-cigarettes that we used are kind of quite out of date now when some don’t even exist um so we’ve got rechargeable cigalike devices the refillable tank devices and then the most recent published study by pasquale caponetto in italy which wasn’t included in our review but has since been published he used a rechargeable pod system but used a much higher strength uh nicotine concentration that is allowed in england in the european union so he used a 50 milligram uh dual device um and what you can see is the the quick rates it it was the the rechargeable pod device the with with the high nicotine strength that appear to have the highest quick worry amongst these participants so 40 after three months we didn’t see any adverse effects on one’s mental health and common side effects as you would expect throat irritation and cough that reduces with continued use so e-cigarettes are helpful for cessation they’re also helpful for harm reduction uh so this is data from 124 people in one of um our local drug and alcohol services in the southland and the marty nhs trust so for a few years we’ve been um within the drug and alcohol service we’ve been offering people a choice of nrt or a disposable e-cigarette a refillable tank device or a um a pod device with nicotine strengths from three to 18 milligrams with the refillable device or 20 milligrams for the pod device and we give people a choice of flavors and we give them 12 weeks behavioral support from a trained tobacco tobacco dependence treatment advisor who was employed by the drug and alcohol service and works there full-time um so what you can see is quite there’s a significant reduction in cigarettes per day um after 12 weeks so from people going from 19 cigarettes a day to 3.6 cigarettes a day what we saw um in our evaluation was a significant reduction in respiratory symptoms within the first month people found e-cigarettes much more helpful for tobacco harm reduction than they did nrt and a third of them are finding e-cigarettes more satisfying than tobacco cigarettes and what we saw was a significant reduction in the urge to smoke as early as week one we also see reduction in withdrawal symptoms by week four in terms of um the reduction in harm so this this is a busy slide but it um it comes from america and it comes from the uk and essentially it it shows that um compared to smokers vapors have much lower levels of carcinogens in their blood and their urine and their saliva than smokers so for carcinogens and nnal it’s 99 lower in vapors compared to smokers and between 59 and 97 percent lower in vapors and smokers in terms of volatile organic compa with volatile organic compounds in terms of the dual users so people who are concurrently vaping and smoking what we saw in the american data is that um jill users had higher levels of carcinogens than people who smoked um so since a lot of this research has come out public health england have been recommending that jewel use so concurrent vaping and smoking should be discouraged unless you’re in that switching transition stage from smoking to vaping and that people who’ve never smoked shouldn’t start vaping debbie we’ve got to wrap up now um is there time just for one more slide yes i’m gonna i’ll be sharing these but i can say that once you open up your e-cigarette policies to allow all types of cigarettes rates of fires go down uh but false alarms go up um and i can just end with my last slide to say that e-cigarettes have the potential to support smok-free policies uh in mental health services but there’s lots of challenges to overcome but those challenges are not insurmountable with effective leadership and systematic systematization and national guidance and workforce training and so on there debbie thank you so much it’s really good to see the the research evidence behind this and uh so that’s fantastic i’m sure we can make these slides available to to everybody to look at in more detail and we’re now going to continue with the theme of e-cigarettes and hear from michelle higgins who’s the physical health lead lead at leeds and yorkshire partnership nhs foundation trust and she’s going to talk about the actual practical uh use of e-cigarettes so over to you michelle hi thank you um so my name is michelle higgins and i’m head of physical health and i work with amanda bailey who’s our um smoke free lead and but unfortunately can’t be here today because she’s on leave so um she would ordinarily be giving this presentation and taking the glory because she’s done the hard work and can you move on the slides please so obviously this is a whistle stop tour about our experience of implementing e-cigarettes but um there’s quite a lot of detail and that we won’t mention in this so we’re really happy to be contacted and share our experience for anybody who needs to do that and i’m just going to talk a little bit about um you know how we started this and um kind of where we’ve ended up really and the various steps along the way so we’re um a mental health and learning disability trust we’ve got units across in york and we’ve also got some specialist services and they include low secure forensic settings um and we’ve got services across the yorkshire and humber region as well next slide please so um in 2016 our first attempt at smurf bean smoke free as a trust uh happened and it was it predates my um coming into the trust but um i believe that there wasn’t any dedicated uh focused support for the for the role and for implementing his work free and and it was sort of responsibility that was added into other people’s roles and they at the time um there was a review done and some of the comments from staff were about there was a lack of ongoing support and because of that like a dedicated role i think and they felt not that they weren’t listened to by the trust when they were expressing concerns about um you know how to deal with non-compliance and we were having a lot of clandestine smoking on trust sites and we’d come to the attention of the um west yorkshire fire um chiefs and because we were having a lot of call outs at that time and all this resulted in um a pause on us for us smoke-free status and the smoking shelters suddenly went back up and next slide please so um we thought about how to do it differently so um in 2018 we appointed amanda who was a smoke-free lead and she had a lot of specialist experience in in the field in public health she’d been working in smoking cessation for quite a long time and she’s also an ex-respiratory nurse so she had a lot of credibility in terms of um you know helping people to stop and having those conversations um we’d reviewed all the feedback from the 2016 attempt at going smoke-free and really what we wanted to do this time was to make our new policy really evidence-based review all that new and up coming through evidence about e-cigarettes and from the public health england review um and e-cigarettes was really a line that we wanted to go down but i do have to say that obviously it was part of a much bigger um smoke-free plan so we we do offer all the other and all the other services the nrt the vernacle and the behavioral support um i think collaboration we knew was going to be the key we had a really spotify safety officer who was really proportionate um and he had a joint agenda obviously because he was wanting to draw us away from the attention of the fire brigades and we’ve presented our proposals to the board and we did quite a lot of costing and some supporting evidence and some of that costing included things like fire damage to the estate and and also and nrt spend and we identified that we weren’t using nrt prescribing nrt particularly effectively at the time and we sought support from our regional colleagues so i know that amanda found the regional forums just absolutely invaluable for doing that touching pace and getting getting your heads together and public health we’re really supportive as well so our tobacco control colleagues and offered support and they were really they offered credibility really to our message because having an outside agency coming in and talking about the benefits of e-cigarettes and the potential there for harm reduction and was was really helpful and you know in in that colleagues weren’t just listening to us and without with our own agenda there was there was somebody else backing us up um next slide please so this slide represents the brick wall that we um well the many brick walls that we came up against so there were many obstacles i think and they were if this was a massive cultural shift for our trust and there was a sense that smoking was so prevalent in the mental health population that this was just too big a task and there were lots of perceptions about alternatives to traditional leonardy so staff were quite well used to nrt and but like i said we weren’t using it particularly um effectively and also and whilst we knew there was good evidence to support use of e-cigarettes and not necessarily everybody was of the same view there were some people with personal objections as as there always is when you’re implementing the change there were safety concerns about the type of e-cigarettes and so that that kind of dictated some of our decisions around the model that we ended up with and and um we also had some issues to bottom really regarding our property because some of our property is not well the majority of our property actually is not owned by the trust it was a pf pfi site so we had to have various agreements with the landlords and work collaboratively collaboratively with them as well next slide please so this is the e-cigarette that we chose and we chose it due to its design it’s tamper evident because it’s uh transparent as you can see so you can see the battery it’s quite evident when somebody’s trying to do things with that that they shouldn’t be doing and compromising the safety of the device um we knew it had been used in secure environments being used in prisons it comes in three flavors and we offered it free of charge and continued to offer it free of charge to win patients subject to a risk assessment obviously not everybody is able to use the e-cigarette and collection and recycling was included in the cost of the device which was really attractive to us and the most attractive thing to us really was they got no link to the back tobacco industry because we’ve gotten a desire to support the tobacco industry um and so we started in september 2019 so exactly two years ago pretty much um with a 12-week pilot on one site now that site was chosen because it’s got a variety of different services including low secure environment and on there we implemented a weekly steering group we were really collaborative in that as you can see we we involved everybody and we had focus groups going um regularly into the wards we did surveys we used questionnaires select suggestion boxes everything we could to try and get feedback from as many people as possible and we piloted it and we did an evaluation which again included the costings and the feedback from service users and staff and created an options appraisal for how we were going to go forward next slide please so these were the things that helped us and the fire safety notice helped us because we had that safety agenda as well the board were generally really supportive providing we could provide them with the evidence and they were all supportive with where we wanted to go with this and listened to us and we had the cost of smoking related damage which was high at the time and we had lots of smoking-related incidents and we as lots of people have spoken about this morning we used a narrative of managing the addiction rather than a punitive um you know stop smoking message so the staff could really and we really reframed that message so that staff could see the health benefits of of um people stopping smoking the pandemic ironically was just so useful to us because and it meant that we could roll out the e-cigarettes really quickly and easily without much opposition due to the first lockdown and when people couldn’t go outside for their smoking breaks and the evidence has generally been supportive in us switching to e-cigarettes and and the healthy living advisors in the healthy living service have been our real allies on the ground just about left michelle okay so two years on um we are fully rolled out with e-cigarettes and we’ve um our plan really is that we need to move more into community services because um we had a plan for that but the pandemic put the kibosh on it really and we’re not where we should be in terms of supporting staff in the wider trust and outside the project the initial project area and that’s because of the pandemic because we’ve all been all pulled onto infection control duties really um but that’s our plan going forward and we’ll continue to review their policy in line with the evidence and and hopefully with the nh and nice guidance that’s due out later in this year i’m really sorry i can’t see the chat box i don’t know whether i should be able to but um if anybody’s got any questions i’m happy to answer or wait for the q a thanks very much indeed michelle we’ll we’ll come back to the questions in the in the q a and we’ll move straight on to mary yates who’s nurse consultant at slam and she’s going to tell us all about the uh the tobacco dependence treatment pathway at slam over to you mary and if we could finish about 10-2 then that’ll give us enough time for uh q a so over to you mary thank you very much adrian and thank you to everyone at ash for such a fantastic um lineup of speakers it’s been wonderful so i think my task is to speak as quickly as possible um obviously i’m representing service users and my colleagues at islam and during this um next few minutes i’m going to talk to you about our experience of going smoke free which we started you can move on to the next slide please um john and we started in 2014 and we had a centralized smoke free team then we learned quite a lot since then and now we’ve got an integrated smoke-free team which i’m going to tell you about so um to begin with we were really pretty rubbish at treating tobacco dependence and i’m ashamed to say to you that i was spending about two or three hours every day undermining health and getting in the way of people recovering um i think we had a very paternalistic approach to care and we were supporting people to smoke rather than being really ambitious about their recovery we needed to change a lot and um we’ve heard during this morning’s presentations about how much we can do and but in the next few minutes i’m just going to focus on one thing only and and that is the treatment pathways now the foundation stone of any good tobacco dependence treatment pathways all of you i’m sure will know is having these three solid foundation stones making sure everyone is asked if they smoke and making sure that they are provided with advice the key issue here is that we are offering support to quit rather than asking the smoker how interested they are in stopping or telling them that they should stop because we know that this leads to more engagements and then finally making it easier for for everyone to be able to connect with that specialist trained advisors next slide please so when we began our journey and if you can click again please john you’ll be able to see those three foundation stones and how we linked them in with our infrastructure so in our electronic patient records system we have an integrated approach to that recording of smoking status provision of advice and then the referrals so in fact the referrals are made automatically so our very busy staff on the front line they just need to ask those three questions click those three buttons and press save and the referrals are then automatically generated and sent to one of our site-based advisors this was in line with the nice guidance ph 48 which said we should all have a site-based advisor for our community patients we started off by connecting everyone automatically with the local stop smoking services what we realized over time and you can move the next slide please john we realized that actually this wasn’t enough this was just the tip of the iceberg and please move on and we thought we had to do quite a lot more to remove those barriers removing those barriers meant we were able to have a a big increase in our engagements when we reflected then on how that was going our patients told us that it was a bit like getting those school reports where um we were told it’s going okay but there’s a lot of room for improvements and you need to do better so the key things they told us was that we were still undermining recovery because there were still some service areas where tobacco was being stored and they said you’ve got to stop doing that they also told us we had to get better at planning leave and avoiding those high-risk situations when people went out on their leave and making sure people had more support to deal with their cravings when they were out of the ward so planning an activity and here you see one of our service users leon who started to use the outdoor gyms which we installed and he found that was a great way of helping uh to deal with the boredom that he experienced in hospital but we also had to make sure we had uh better supplies and better access to nicotine replacement therapy and better access to e-cigarettes as well and critically uh what we learned from our patients was that they said it was all very well and good helping them to stop smoking when they’re in hospital but if we didn’t continue to do that and we were not able to build and maintain on the health gains that people achieved it was all a bit pointless so they were very clear in telling us that it was that critical point at discharge where people really needed the support because that was the high risk of relapse next please so leon’s story uh it was very compelling because he said it’s really too hard for me to walk past the nurse’s office if you’ve got my in there and he really was very clear to us that if we believe that he could quit smoking we needed to make it easier for him uh and give him the option uh to to do better and particularly to help him as he was leaving hospital next please so here i’ve just highlighted some of our policy changes and we’ve reviewed our policy twice now since 2014 the first time uh was in 2016 where we made that promise that we would stop undermining recovery and stop storing tobacco we also made greater efforts to help develop smoke-free leave plans and better discharge plans and we integrated routine uh carbon monoxide monitoring the way we batched it was you know if staff are caring for diabetic patients in our mental health services then we regularly monitor the blood sugar levels so if we’re caring for a smoker we need to be regularly monitoring the carbon monoxide levels we also made sure varenicline was available since 2019 we have a more integrated care model and this has been well described to us earlier by our colleagues at elft and so we have now 12 tobacco dependence advisors and they work across the care pathway so they get to know patients when they are admitted and they give them the opportunity to continue their treatment program after discharge for up to 12 weeks and we’re very excited because we’ve just got the green light to appoint two new tobacco dependence advisors specifically in our cans care pathway where again we’re going to be caring for those young people right across the care pathway regardless of whether they’re in hospital beds or whether they’re in the community and we’ve bolstered that up by providing free e-cigarettes and and it’s great to hear about leeds program but we’ve chosen a a different product a product that can be easily accessible in the local community here in south london and that’s affordable and that’s available in a range of nicotine options so from 18 milligrams all the way down to zero strength and we think that’s really important and to help smokers to quit as soon as possible and for good so next slide please i think what really was very compelling for us was when we looked at how well our service users do when they get referred by us to the local stop smoking services so this is just one of the local authority data we referred 189 patients to them and just four of them were helped to quit and i think this highlighted really the failure in the local stop smoking services to help our patients to quit next slide please um here’s an example of one of our patients who did really well with jill and my colleague at mordsley hospital so um this lady started smoking at the age of 15. she smoked 60 a day when jill met her and jill was able to help her to quit while she was in hospital and then continue to support her after she went back home and my next slide which i think is my last one and uh i can see adrian is smiling when i said that so um these are our 14 c’s these are our top tips for successful smoke-free services we think it’s so important that you’ve got to co-design co-produce and co-deliver these tobacco dependence programs we need to have a lot of courage to challenge the poor practice that we see related to smoking and also catch people doing the right thing so that encourages them to keep doing us make sure that we communicate the changes very clearly using good leadership and have care pathways not only for patients but also for staff and i think others have said that earlier today as well be really compassionate because we know tobacco dependence is a chronic relapsing condition usually established in childhood and extends right through the life years so we’ve got to really be mindful of that and know that we’ve got to have a competent workforce to deal with it because it’s a tricky thing and we’ve got to be consistent in the care across the pathway we also need to collaborate outside of our organizations as well as inside and make sure we’re keeping the track on the data it’s a long journey but it certainly is a rewarding and of course we love to celebrate some success stories as well so that’s all from me happy to answer any questions and thank you again to ash well thank you so much uh mary i love the 14 c’s i’m sure again we’ll send the slides around so that people can make a note of them just like to ask all our presenters now to join us for which just over five minutes for q a would remind anybody that’s got questions if we don’t manage to answer them now we will collate them and we’ll get back to you with the the answers as much as as we can now we have had a question about um storage of tobacco cigarettes when somebody is an inpatient marriage you had a very clear stand on that that you didn’t store tobacco um products and then give them back to patients for example going on on leave or when they’re discharged i wonder what the other panel members felt about that i mean perhaps um hannah and kevin you might want to say from a lived experience point of view what your view is on that hannah um so yeah so my secure unit did that and um it ended up being quite bad for the patients because they weren’t allowed to store anything on site so they go out they buy 20 cigarettes because you can’t buy 10 anymore and they would smoke as many as they could and then they would bury them outside in the grounds um you know catching god knows what kind of bugs and and they’d smoke as many as they could in that little about a time so if they had to say 15 minutes break 15 minutes unescorted they would smoke as bit literally as many as they could that that messes up with your closing levels your antipsychotic levels if you take in that much amount of nicotine and why such a small time so i think that’s quite a difficult one i think although you’re doing it to protect them you’re actually probably making it worse for them because they’re smoking so many cigarettes in such a short amount of time and when they don’t need to you know i i know i did it so yeah kevin if you wanted to come in yeah yeah it’s the same for me like with any addiction if you if i’m prevented from engaging in an addiction whether it’s alcohol substances or tobacco and then i’m given the opportunity that i’m going to indulge as much as i can um you know i i’ve had conversations with matrons on wards that have said that they’ve seen so she’s just scrabbling around in in um hedge rows in flower beds where they’re buried tobacco products in the rain they’re out there scrambling around they can’t find it i mean you know i keep coming back to the bit about not setting people up to fail and making every contact count whatever interventions we have for people on inpatient boards needs to follow people into community mental health teams and primary care that’s what’s key to this and like with any addiction sometimes you’ve just got to hit rock bottom but we’ve got to be able to support people to continue um in a positive way to keep engaging in trying to support people but yeah i feel the same i’ll come back to the the transition into the community but uh angela debbie or mary do you want to come in i think mary you made your stance very clear what’s your view on this angela thank you i think um if we are still rubbish at supporting people to get access to nicotine which i think many of us still are so if we are under treating people with nrt or providing them with e-cigarettes that are not really um right for them then people will really struggle when they’re out on their leave and if we’re still very poor at giving people meaningful alternative activities to engage with then we are going to continue to to struggle and people will be forced um to engage in the behaviors that hannah and kevin have described and there’s nothing worse than seeing somebody you know hiding their cigarettes in the bushes and or you know doing what hannah said but that’s a failure on me if i’m in that service and somebody is doing that that’s because i’m still rubbish at treating tobacco dependence on you know hopefully i’m getting better okay angela or debbie now i would just echo what mary’s just said and and i totally acknowledge what what hannah and james say kevin said in terms of their stories we’re here from up up and down the country but with with we need to get the beginning of that that treatment pathway right so we’ve got alternative satisfying and acceptable alternative sources of nicotine available to people okay that’s great actually i’ll move on to the next question perhaps i’ll start with with uh angela the the transition into the community uh that’s a time when uh people are most at risk really and need support and the the link up sometimes with community services is really very challenging to say something about that yeah that was that’s the biggest thing that’s come out of all of our engagement work with with service users and and um experts by experience who’ve gone through our services and the staff as well was um how do we how do we make smoking if you’re still smoking or if you’re deciding to stay acquainted and how do we make that core part of your recovery so when we’re talking about the rest of your life post being an inpatient how do we remain smoke free as part of that and i think it was definitely felt that that kind of referral on to a community service of which the patient had never potentially met them or knew them wasn’t working you saw from our data it clearly wasn’t working and i think that idea that they you know it’s probably like mary’s model at slam where they they stop smoking advisor as part of your recovery they’re part of your community mental health they’re part of those conversations around how’s it going how’s your medication how’s your housing you know and and linking in very much with our peer support workers around that idea around isolation and loneliness and linking them to lots of other activities and befriending and support that we we also we’re going to evaluate we think will really help that kind of abstinence because we do see even if you’ve quit with us as an inpatient the take-up rate once you’re discharged is really high anyone else want to come in on this no uh there’s uh one final question just very briefly to you all about the role of the cqc could the inspectorate be more engaged in this agenda anyone want to come in on that one mary thank you i think this is a great question because i think it’s been quite confusing for us to see cqc inspectors awarding excellent ratings to services where we have health and well-being undermined by staff who are spending more time helping smokers to continue smoking rather than helping them to quit and i think that’s been difficult for services who’ve really worked hard and to then you know not have that acknowledged and in fact i’ve seen some services have been required to put in place storage facilities for cigarettes and tobacco paraphernalia so this is very confusing and i i would like us to ask the cqc to be really clear and really consistent and recognize that tobacco dependence is the leading cause of preventable disease and premature mortality for people with mental health problems and if we are going to you know level up if we’re going to have a fair society there has to be consistency and there has to be a commitment uh to prioritizing this treatment for everyone and particularly for people with mental health and learning disabilities okay we can have to finish there but um kevin just give you the final word so i i think there is a real uh conversation to be had around workforce culture in this because a lot of staff see it as a human right and they don’t want to have conversations with service users about mechanisms that service users find useful in in managing their mental ill health and and and see it as a risk to a therapeutic relationship um whilst maybe making poor lifestyle choices themselves so i i think i think the messaging needs to be correct and and many staff don’t agree with smoking cessation policies within mental health trust so i think there’s significant amount of work to do around that okay well thanks uh for that maybe we should say no outstanding ratings unless you get your act together in relation to this so um it uh just wanted to say a big thank you to all our speakers thank you so much that was really amazing to hear about the the evidence the possibilities uh and the success and particularly uh lived experience uh and the the success and what that means to people in their lives and and the gains so thank you so much uh thank you um to all of you for attending thanks for your questions ones that haven’t been answered we’ll get back to you a big thank you to ash and mental health smoking partnership for all the work you’re doing and for the organization particularly hazel and john uh just a reminder we’ve got a slide up there thank you for the uh the the applause um for the organizers thank you so much and um just a reminder that in your in the um the links that you had you have the links to the public health england uh nhs long-term plan regional sessions so if you want to go straight to those um more learning and more engagement so thank you so much thank you for attending and thank you for all you’re doing in really pushing forward this this agenda but we’ve really got to do more in the next decade we don’t want to be where we are now so thank you
ASH and the Mental Health and Smoking Partnership hosted a webinar on the smoking and mental health components in the NHS Long Term Plan (LTP).
0:00 – 04:44 Chair’s opening address Dr Adrian James, President, Royal College of Psychiatrists
04:44 – 17:21 Professor Ann McNeil – Why we need to address smoking now
17:21 – 30:44 Professor Tim Kendall – The NHS Long Term Plan in Mental Health services
30:45 – 38:48 Q&A on the NHS LTP – Professor Tim Kendall and Professor Sanjay Agrawal
38:49 – 49:47 Early implementer site update – Angela Bartley
49:47 – 58:19 Spotlight on training – supporting and empowering staff and patients – Lisa Evans
58:19 – 1:08:45 Expert by experience – Hannah Moore
1:08:45 – 1:19:36 Expert by experience – Kevin James
1:19:38 – 1:31:02 E-cigarettes: how they can support a smokefree future in mental health services – Dr Debbie Robson
1:3:02 – 1:41:15 Using e-cigarettes to become smokefree – Michelle Higgins
1:41:15 – 1:52:10 An integrated smokefree service model – Mary Yates
1:52:10 – 2:01:00 Q&A – all panellists
2:01:00 – 2:02:04 Closing remarks – Chair
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