A smoking cessation pilot program Keep Quitting in Mind – designed specifically for people living with severe mental illness – has helped one in nine participants quit smoking, demonstrating the positive impacts that are possible for an at-risk yet typically overlooked population group. 

Of participants in the study who didn’t quit, almost 60 percent reduced their daily smoking rates by half.  

The results of this pilot program – which were recently published in the Journal of Psychiatric and Mental Health Nursing – also shows the strong motivation of people living with mental illness to quit when they are offered evidence-based strategies. 

With a mental health nurse specialised in tobacco cessation training, the Keep Quitting in Mind program helps people with mental illness develop a renewed sense of purpose, improved self-esteem and a sense of control over their health outcomes. 

Smoking is the most common substance use disorder amongst people living with severe mental illness. Compared to the general population, they are at higher risk of smoking and this contributes to their reduced life expectancy of up to 15 years. reduced life expectancy of up to 15 years. 

Given these facts, it’s urgent that society provides tailored smoking cessation programs for people experiencing mental illness. 

Tailored support 

In Australia, the USA and the UK, people living with mental illness consume approximately half of all cigarettes sold. They also face additional barriers to quitting due to the unique lifestyle challenges they often face, which can include social isolation, community stigma and sedentary lifestyles.lifestyle challenges they often face, which can include social isolation, community stigma and sedentary lifestyles. 

Around 60 percent of people with mental illness are tobacco smokers, so it’s concerning that smoking rates have remained relatively unchanged in this group, despite significant reductions in smoking rates in the general population over recent decades.group, despite significant reductions in smoking rates in the general population over recent decades. 

It’s urgent that we do all that we can to help people with severe mental illness quit smoking, and the Keep Quitting in Mind program was specifically designed to address their unique needs, focusing specifically on their experiences and outcomes. 

Between July 2018 and December 2020, our team at Mindgardens Neuroscience Network worked collaboratively with the South Eastern Sydney Local Health District (SESLHD) to develop and deliver Keep Quitting in Mind through community mental health services. 

A mental health nurse specialising in tobacco cessation training conducted an initial assessment face-to-face, focused on the person’s current smoking status, previous quit attempts, their goals, barriers to quitting and support needs. 

The nurse also offered advice on the use of quitting products such as nicotine replacement therapies and managing side effects, helped participants develop alternative coping strategies and worked with them to address their beliefs about the use of tobacco to self-manage mental health symptoms. 

In total, 99 adult participants with severe mental illness who were a current tobacco smoker, or recently ceased tobacco smoker, participated in the pilot program, with similar numbers of men and women and the majority of participants aged in their 30s and 40s. 

Encouragingly, the program is now being offered as part of routine care in the South Eastern Sydney Local Health District.  

It’s time to see interventions like the Keep Quitting in Mind program made more widely available through all public mental health services across the country.  

Life-saving programs like this don’t only help those directly impacted by smoking – they also reduce the financial impact on the health system. 

While the pilot program showed promising results in supporting people with severe mental illness quit or reduce smoking, the study had some limitations. For example, the absence of a control group limits the ability to generalise the effectiveness findings. 

Additionally, we did not measure the acceptability of the intervention to participants, which would have helped us better understand any barriers and enablers to program participation. 

The low completion rate for some outcome measures also limits the effectiveness findings. The time to complete questionnaires and difficulty for participants to concentrate when completing them were also reported as contributing to low completion rates. 

These factors should be considered in the design of future smoking cessation program for people living with mental illness. 

The pilot study did not include interventions to help participants quit or reduce vaping, though the tobacco specialist in the ongoing Keep Quitting in Mind program does provide this assistance when requested. Vaping is an emerging health concern which requires additional research before tailored cessation programs can be provided. 

Currently, no targeted vaping cessation programs exist for people with mental illness, despite studies showing a higher prevalence of vaping among people with mental illness or experiencing psychological distress. Since the rapid increase in vaping in recent years, the NSW Ministry of Health has begun to support vaping interventions.  

Mindgardens will start a research project to understand the vaping prevalence and practices of young people with mental illness, which will include a survey and qualitative interviews. Its findings will be used to develop a vaping intervention for this group. 

Keep Quitting in Mind is part of the Keeping the Body in Mind(gardens) suite of research programs focused on improving the physical health of people living with severe mental illness. 

This opinion editorial was originally published in Croakey Health Media: Tailored support to help people with severe mental illness reduce or quit smoking – Croakey Health Media

About the author and acknowledgements 

Professor Jackie Curtis is the Executive Director of Mindgardens. She is a psychiatrist and was previously the Clinical Director of Youth Mental Health at the South Eastern Sydney Local Health District. Her work has focused on early psychosis and youth mental health, including improving the health of people living with serious mental disorders with the aim of reducing health inequalities and increasing life expectancy. 

Professor Curtis would like to acknowledge the commitment of everyone involved – especially the participants, who achieved these outstanding results. She is incredibly proud of the role Mindgardens played in supporting Keep Quitting in Mind, alongside SESLHD, which will provide life-long benefits to people living with mental illness. Together we have shown people experiencing severe mental illness can stop smoking.