The facts about the effects of smoking tobacco on individuals with serious mental illness are astounding. Current literature reflects that smoking tobacco drastically affects the unique biological, psychological, and social well-being of individuals with psychiatric disabilities. The National Association of State and Mental Health Program Directors (October 2006) notes that these individuals are more than twice as likely to smoke and their life expectancy is 25 years less than the general population. According to an article in the American Journal of Medical Sciences, about 75% of individuals with serious mental illness smoke, and most will die or have a reduced quality of life because of tobacco-related medical diseases (Am J Med Sci. 326, 223).
Membership Has Its Privileges
Clubhouse of Suffolk (www.clubhouseofsuffolk.org),
a private, not-for-profit rehabilitation agency in Ronkonkoma, N.Y., was awarded a two-year grant by the New York State Department of Health through its tobacco control program to develop, implement, and evaluate an intervention for addressing tobacco use in individuals with serious mental illness.
The initial step was to understand the culture of the organization and to design a program that could be incorporated easily into the philosophy and structure of Clubhouse. To be consistent with the philosophy of empowerment, the members of Clubhouse were partners in the development and implementation of the project. Establishing an atmosphere of trust and inclusion that was consistent with the program goals was imperative to achieve staff and member buy in. To accomplish this, a multidisciplinary team approach was used that included nursing, social work, and administrative staff.Peer counseling sessions were led by members who had been smoke-free for six months, adding another source of support for those trying to quit.
An eight-week wellness program was open to all members of clubhouse, regardless of their smoking status. The strategy was to attract the lower-motivated smoker by offering education that covered areas of nutrition, exercise, stress management, and activities to promote a healthy lifestyle. After the completion of the program, those
individuals who wanted further support to stop smoking graduated into smoking cessation classes. In addition to psycho-educational classes, counseling was provided by the social worker and nurse practitioner, using client-centered motivational enhancement therapy. Peer counseling sessions were held three times a week, led by members who had been smoke-free for six months, which added another source of ongoing support.
The entire Clubhouse community developed Wellness Fairs, and eventually members of neighboring Mental Health Programs were invited to participate.
The wellness fair is now an annually scheduled activity that incorporates smoking cessation into the system of care.
Staff was trained to address tobacco use with each member at Clubhouse, and relate it to one of that patients treatment goals. It was hoped that this would ensure a shift to a culture of healthy living that would be sustainable long after the NYSDOH-supported project was completed.
Awareness of the dangers of smoking has become a part of all programs offered at Clubhouse of Suffolk. Smoking at Clubhouse has been transformed into a culture where members now have opportunities and ongoing support to replace cigarette smoking with healthy activities. As one member of Clubhouse said, Just because I have a mental illness does not mean that I do not deserve to have good things happen to me.
Nurses are in a unique position to support individuals with mental illness who wish to stop smoking and to let the community at large know that the activity of smoking can be replaced with truly transformative therapeutic relationships.