‘They’re Going to Smoke Anyway’: A Qualitative Study of Community Mental Health Staff and Consumer Perspectives on the Role of Social and Living Environments in Tobacco Use and Cessation

Abstract

Background: Addressing the high prevalence of tobacco use experienced by people with severe mental illness (SMI) requires consideration of the influence of wider cultural, socioeconomic and environmental factors. This qualitative study aimed to examine the impact of social and living environments on tobacco use and cessation by people with SMI accessing community managed mental health services. The perspectives of both staff and consumers with SMI were explored. Methods: Semi-structured focus groups were undertaken with a purposive sample of community mental health staff and consumers from three sites in three major cities in NSW, Australia. Two sites provided outreach support, and one site provided residential support. Data were collected (2017–2018) until saturation was reached. Focus groups were audio-recorded and transcribed, and thematic analysis was conducted. Results: Thirty-one staff and 17 consumers participated separately in six focus groups. Themes identified by staff included a degree of fatalism, conceptualising tobacco use as choice rather than addiction and tensions between cessation support and broader models of care. Staff viewed smoke-free home and mental health service policies as effective at promoting quitting but contradictory to recovery-oriented models of care. Consumers identified smoking as an integral part of life and social networks, as a way of maintaining control and lack of social support to quit as key themes. While many consumers reported smoking inside the home, others described enforcing smoke-free rules. Conclusion: Social and living environments played an integral role in tobacco use and cessation for both staff and consumers. The role of community managed mental health organisations in addressing tobacco use within social and living environments was not strongly supported by staff and sometimes seen as antithetical to recovery-oriented models of care. Potential ways to address this include education and training for prospective and current community mental health organisation staff highlighting the synergy between the recovery-oriented model and provision of preventive health support.

Monitoring changes in smoking and quitting behaviours among Australians with and without mental illness over 15 years

“…Nonetheless, for the most recent survey period (2016-2019), the prevalence of regular smoking decreased and there was an increase in the proportion who had quit, indicating some headway in increasing smoking cessation among people with mental illness in Australia. In contrast to common beliefs that smokers with mental illness do not want to quit, 19,31 results show that while smokers with mental illness reported greater tobacco consumption, they were just as likely to make quit attempts and were often more likely to use cessation aids. However, they reported less success in their quitting efforts.…”

Cross-Sectional Associations of Self-Reported Social/Emotional Support and Life Satisfaction with Smoking and Vaping Status in Adults

“…Social and emotional support is defined as the social resources that one receives as a result of empathetic, caring, and reassuring communication from non-professionals [ 26 ]. As moderators of stress, social and emotional support are usually regarded as an essential factor for smoking cessation, although their exact role remains controversial [ 27 , 28 ]. Several studies have shown that positive social and emotional support are associated with successful smoking cessation and prevention of relapse [ 29 , 30 , 31 ].…”

Opinion and perception of attitudes related to smoking and its prohibition in mental health services

“…Esos resultados están en consonancia con la literatura científica que muestra que el tabaco está siendo utilizado, hace muchos años, como una forma de: recompensar los buenos comportamientos de los pacientes psiquiátricos; controlar sus síntomas; incentivarlos a ser menos resistentes a los planos de cuidado, y facilitar las interacciones. Además, en algunas situaciones es utilizado como chantaje (3,4,(15)(16)(17)(18)(19) .…”

“…A pesar de que el uso de cigarrillos como instrumento de cuidado (para facilitar diálogo o negociar con los pacientes) sea una característica de los antiguos manicomios, estudios actuales han discutido ese comportamiento mostrando la dificultad de que esa cultura sea superada en los servicios de salud mental (16,18,19) .…”