Mental health services, tobacco control programs must work together to encourage smoking cessation

Persons with mental illness account for more than one-third of adult smokers in the United States and despite a decline in tobacco use during the past five decades, there has been no change in the smoking rate for patients with poor mental health. To combat reliance on tobacco in mental health populations, experts agree that mental health services and government-sponsored tobacco control programs must work together to improve education and access to smoking cessation programs.

"Historically, mental health care has operated separately from general medical practices where collaborations exist to strongly encourage smoking cessation in typical patient populations," said Jill M. Williams, MD, professor of psychiatry at Rutgers Robert Wood Johnson Medical School.

The result of this disconnect, according to Dr. Williams, has left smokers with disparities to become the dominant group of smokers in the United States. This includes smokers with mental illness, as well as other addictions and the very poor. "Disparities research indicates we need tailored strategies to effect these remaining populations of smokers," she said.

In a Viewpoint piece published Online First on October 30 in the Journal of the American Medical Association Psychiatry, Williams said partnerships between mental health providers and state or county tobacco control programs benefit patients, providers and programs. For patients, smoking cessation improves their health by reducing the impact of smoking-related illnesses. This, in turn, lowers costs in treating those illnesses.

"The paradox is that we still pay for the heart disease and cancer that these smokers develop so it makes more sense to help them stop smoking," explained Williams, who recently became chair of New Jersey Breathes, a coalition working for a tobacco-free New Jersey. "We must recognize that smoking has not disappeared, but has become a vital issue for New Jersey's most vulnerable citizens, just as it has nationwide. We need the types of prevention and cessation services that existed when New Jersey had a Comprehensive Tobacco Control Program."

New Jersey eliminated its program in 2010 due to budget cuts leaving millions of smokers without options. Williams cites comprehensive state-run tobacco programs in California and Massachusetts, which have resulted in savings in health care in less than five years. New Jersey nets more than 700 million dollars every year in taxes from cigarettes yet doesn't designate any of that money to be used for programs to help smokers.

In the Viewpoint piece, Williams, along with Jeffrey G. Willet, PhD, from Kansas Health Foundation and Gregory Miller, MD, MBA, from the New York State Office of Mental Health, underscore the benefits to patients noting that collaborative efforts increase opportunities for prevention and wellness services, and broaden access through clinical care. Whereas, the treatment for tobacco dependence has typically been delivered in primary care settings, linking mental health facilities with state and county tobacco control programs allows smoking cessation education to be incorporated into counseling and encourages mental health providers to promote tobacco quit programs during face-to-face interactions with patients.

Likewise, tobacco control programs, already leaders in advocacy, can emphasize the need for smoking cessation programs and policies that focus specifically on underserved populations, including individuals with mental health illness.

For healthcare providers, integrated programs could provide strategies for improving Medicaid reimbursement of tobacco treatment services. Medicaid is the primary health insurer for persons with mental illness in the U.S. and mental health providers can utilize their experience with Medicaid to expand tobacco treatment through partnerships with tobacco control programs.

"Ultimately, coordinated efforts can strengthen and expand treatment programs, control healthcare costs, and improve the well-being of individuals with mental illness and other disparate populations, which have limited access to smoking cessation options," said Williams.