Serious Mental Illness & Tobacco Use

After I parked my car and was walking to the entrance of the Behavioral Health Pavilion recently, I was asked by a patient who said she was just discharged from the Crisis Response Center (after a 36-hour stay) if I had “a smoke.”  
 
I do not smoke cigarettes and know that smoking cigarettes is a risk for cancer and other illnesses.  At that moment, however, I wished that I did have a “smoke” to share with this person who said, “if I don’t get a smoke soon, I’m going to wind up back at the CRC.”
 
The first paragraph of a recently published article in JAMA Psychiatry about rates of smoking among patients with Serious Mental Illness (SMI) articulately describes the scope of the problem: Individuals with serious mental illness (SMI) smoke cigarettes at disproportionately higher rates, are more likely to smoke heavily, and have lower cessation rates than the general population. Adults with SMI who smoke cigarettes consume almost half (44.3%) of all cigarettes smoked in the U.S. and have lifespans 25 to 32 years shorter than the general population. Cigarette smoking has been identified as an important modifiable risk factor for excess mortality in people with SMI. 
 
When we are in our clinics, caring for inpatients, or providing consults, it is rare that the chief complaint is ever “Doc, can you help me quit smoking?”.  As experts in psychiatry and behavioral health, our goals are to: 1) treat the index psychiatric illness and prevent recurrence; 2) treat comorbid psychiatric conditions, including substance abuse and dependence; 3) optimize care of medical conditions; and 4) promote healthy behaviors and reduce risk factors for psychosocial and medical deterioration. 
 
Since smoking makes us sick and being sick worsens psychiatric illness, we owe it to our patients to spend more time on smoking cessation. Indeed, there are two tobacco cessation measures that are part of CMS’s Inpatient Psychiatric Facility Quality Reporting (IPFQR) Core Measures. One is related to the percentage of patients receiving tobacco cessation counseling and nicotine replacement therapy while inpatient. The other is the percentage of patients who, at discharge, receive a referral for continued cessation treatment and a prescription for nicotine replacement therapy. The IPFQR Core Measures are among the few publicly reported measures about inpatient psychiatric care, so not only is it good for our patients, but it’s good for our hospital’s public profile. For both inpatients and outpatients, referring patients to the ASHLINE (Arizona Smokers’ Helpline) is an often underutilized (and free) resource.