Services for vulnerable groups

12.1 Smoking and mental health

Smoking has a significant impact on the health of people with mental health illness and is a Public Health concern. Smoking rates are higher than in the general population and have a disproportionate impact on morbidity and mortality of people with mental health problems (McManus et al, 2010).

Smoking prevalence varies across the mental health diagnosis (McNeill, 2001; Meltzer et al., 1995) and is highest amongst those with schizophrenia, neurotic disorders, affective psychosis and homeless people. Whilst prevalence of psychotic disorder is low in the general population (Coulthard et al., 2000; McNeill, 2004), one in four British adults experience at least one diagnosable mental health problem in any one year, and one in six people experience this at any given time (Office for National Statistics, 2001).

In Wales, smoke free legislation has provided exemption to mental health units that provide residential accommodation to patients. The Welsh Regulations provide for a permanent exemption, where Hospital managers can provide designated smoking rooms (National Assembly for Wales, 2007). The service is currently working with mental health Services to explore options for restricting smoking in inpatient facilities in Wales.

Stop Smoking Wales continues to provide behavioural support for clients with mental health problems who live in the community and who would like to give up smoking. It does not however, provide the service for inpatients in mental health care hospitals. Nevertheless, the plan is to provide a ‗mental health toolkit,‘ to emulate the ‗prison toolkit‘ for mental health staff to deliver smoking cessation support to clients.

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Stop Smoking Wales does not record the client‘s health status and therefore, it is not routinely possible to report on the number of clients with a mental health illness that use the service.

During 2012/13, Stop Smoking Wales will work with partners in mental health care settings to:

provide brief intervention training for mental health practitioners working in community settings

promote and encourage smoke free environments in hospital settings and address the cultural barriers in this setting

arrange training for Stop Smoking Wales staff in working with clients with mental health problems

develop a mental health smoking cessation toolkit

12.2 Young People

The current pattern of smoking in children and young people illustrates health inequity in Wales. The most recent data on school aged children and smoking shows that children from the most affluent families are less likely to smoke than those from the middle and lowest affluence groups, (Welsh Government, 2011). Children from the least affluent families also start smoking at a younger age and are more likely than those in the highest affluence group to have smoked by the age of 13. This has relevance to smoking cessation services, as the earlier an individual starts to smoke, the more dependent they are as adult regular smokers and the more they require intensive behavioural support to successfully stop smoking.

The Health Behaviour of School-aged Children (HBSC) report in 2009/10, looked at the health of children in 39 countries. Presently in Wales 0.5 per cent of 11-year old children reported smoking at least once a week and amongst 13-year olds, 2.7 per cent of boys and 5.2 per cent girls

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report smoking at least once a week (HBSC, 2009/10). Amongst 15-year olds, 9.6 per cent boys and 14.8 per cent girls report smoking at least once a week (HBSC, 2009/10).

Girls are more likely to smoke than boys, and more likely to start smoking at a younger age. Regular smoking behaviour increases between the ages of 11 and 16 years.

Young smokers‘ patterns and levels of smoking are often different from those of longer, established adult smokers. Whilst delivering smoking cessation services is well documented as an effective intervention to help adults to stop smoking (West et al, 2000), there is relatively little research on effective smoking cessation interventions for young people to inform the development of these services (Thomas and Perera, 2006).

Stop Smoking Wales continues to seek out new work in this to identify promising approaches in the field as they emerge. This is also identified as an area for research and development. Separate national guidance applies to smoking prevention strategies which is outside the remit of this report (NICE, 2008, 2010b).

Stop Smoking Wales provides support to young people, aged 12-17, who classify themselves as smokers, to help them stop smoking. These sessions are delivered on a one-to-one basis.

A total of 184 females and 135 males under the age of 18 accessed the services of Stop Smoking Wales during 2011/12. Activity and outcomes for young people who attended the service in 2011/12 are reported in Appendix 2.

Stop Smoking Wales will continue to support young people on a one to one basis. The service will also ensure that Stop Smoking Wales materials are available in educational and other appropriate settings so that young people, aged 12 to 17, who want to stop smoking are aware of the service. As previously stated, Stop Smoking Wales will support and

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refer clients to our partner organisation ASH, that are setting up an innovative service for young people.

12.3 Prison health

There are five prisons in Wales: HMP Swansea, HMP Usk, HMP Prescoed, HMP Cardiff and HMP Parc in Bridgend (Parc is managed through the private sector), all of which are located in South Wales. The total prison population in Wales in March 2012 was 3178 (HM Prison Service, 2012) and it is estimated that around 80 per cent of prisoners smoke (Department of Health, 2003). Health Needs Assessments were conducted by Public Health Wales during 2009 for each prison in Wales, and have highlighted smoking cessation as a priority, because of the high smoking rates within this population. Stop Smoking Wales has established partnerships with each prison site to discuss and address smoking issues since this date.

12.3.1 Stop smoking in prisons toolkit

Stop Smoking Wales has developed a ‗Stop Smoking in Prison Toolkit‘ to support access to consistent and effective smoking cessation services for smokers within prison settings who would like to stop smoking. The toolkit contains a smoking cessation service delivery model for the prison setting, outlining the evidence base and recommended approach for delivering smoking cessation support in this setting.

The standard Stop Smoking Wales six-week intense behavioural support programme has been tailored specifically for the prison setting, to address the needs of the target population.

The approach taken involves prison staff delivering the behavioural support programme in-house. Protocols and guidelines have been written to support prison staff with service delivery. The ‗Stop Smoking in Prisons Toolkit‘ has now been presented to each Prison Health Partnership Board for agreement during 2011/12.

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It is anticipated that Prisons will identify dedicated prison staff and arrange appropriate training to deliver the Stop Smoking Wales behavioural support programme using the toolkit. Stop Smoking Wales will provide support to prisons to ensure consistency of intervention, collate information and adherence to best practice.

I would have liked to see the course run for longer, i.e. monthly after the 6 weeks

Male 50 years

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