Take a deep breath in, pause, and then slowly exhale. Did you notice anything? If you are anywhere on WCMHS property, you can be sure that breath of air was smoke-free. The Tobacco-Free Workplace Committee of WCMHS has worked for several years to develop policies and procedures for WCMHS to become fully tobacco-free. The policy became effective on July 1, 2015, and placed requirements on all programs, buildings and grounds within the agency to be tobacco-free. We have been implementing that policy during the past year and a half and have been collaborating with WCMHS staff and clients in a cooperative effort to resolve problems as they have arisen.
Several challenges were successfully addressed and overcome to enable the success of our smoke-free campus. A key factor to consider was the perspective of individuals who smoke, including staff and clients. Smokers felt discriminated against and felt that tobacco use was an important way they dealt with their mental health. WCMHS acknowledged the needs of smokers while framing the issue for what it really was – protecting the health of all its staff and clients. The leadership at WCMHS maintained open communication with individuals who smoked, while explaining that it wasn’t a matter of not allowing people to smoke, but rather ensuring a holistic approach to health and ensuring that people were not exposed to secondhand smoke.
Working with a mental health population meant a large portion of our clients do smoke. This is a detail that had to be addressed when looking at the overall health of our clients in addition to the success of the new policy. Significant disparities in tobacco use prevalence exist in populations with mental health and substance use conditions. Forty percent of all cigarettes smoked are done so by adults with mental illness and/or substance use issues. In Vermont, the smoking prevalence among those with mental illness is 38%, compared with 18% in the general population. In addition to a higher smoking prevalence, individuals in the mental health/substance use population are often more heavily addicted, smoke with more frequency, and are more impacted by tobacco’s harmful effects (SAMHSA, 2013). Evidence shows that this population wants to quit; however, more support, resources and assistance may be needed to succeed in quitting tobacco.
Studies indicate that individuals with serious mental illness are at risk of dying 25 years younger than the general population due to conditions resulting from lifestyle choices, including a high prevalence of smoking. (Rosenberg, L. Addressing a national tragedy: primary care/behavioral health coordination is key to improving and extending consumer’s lives, 2006). As we strive to work on holistic and integrated health modalities, it is critical we help address tobacco use among our clients. Mental health and substance abuse treatment facilities can play an integral role in promoting and supporting cessation efforts through implementing tobacco-free campus policies to ensure a healthy, smoke-free environment as well integrating cessation services into treatment facilities.
WCMHS has become one of the first mental health and substance use facilities in Vermont to successfully implement a tobacco-free policy. Reports from this most recent update in policy have been favorable. Reports from several residential and day treatment facilities indicate that consumers are working with staff to respect the established tobacco-free policy by leaving campus to smoke and ensuring that people are not exposed to secondhand smoke at the facility. Additional reports indicate that there have been positive results with some consumers quitting smoking completely or moving towards this goal through education, group and individual support, and nicotine replacement therapies. This initial shift in smoking has the potential to continue to shape social norms around smoking across all of WCMHS facilities, helping to establish WCMHS as a treatment organization with a holistic approach to health.
Overall the staff and client responses to our tobacco-free initiatives have been positive. One CSP staff recently commented on the policy, “I smoke, and this hasn’t bothered me. It has actually helped me smoke less during my work day has made me start the quitting process.” Residential and day program staff have reported a perceived decrease in overall smoking and do not receive as many complaints now that this policy has been in effect for upwards of two years in many programs.
We have experienced some push-back and concernsdo arise as well. Residential programs observe the most frequent concerns and challenges. When asked about her thoughts, a residential staff expressed some reasonable concerns and thoughts about the policy. “I’ve worked in a residential program for almost a year and a half. Many of our clients are smokers. While we all know smoking is unhealthy, it is a vice that some tend to hang on to. Just about every client that we have had that is a smoker has expressed a desire to quit, however, the focus of them being in a residential is to work on recovery. To maintain their stability they often continue to smoke. I wish that there was a smoking area on the property instead of making clients stand on the sidewalk to smoke – which can be a bit demeaning. We all hope that someday they will be able to quit and not need that vice, or replace it with a healthier vice, but the reality is that it’s not going to happen right away.”
The tobacco cessation committee at WCMHS continues to plan for the future as we address concerns and issues as they arise. The committee envisions the program expanding to include more offerings for clients and for staff. Bill Fagginger-Auer continues to offer a weekly smoking cessation meeting available to CSP clients. The group has been meeting for years and is a helpful peer support tool for many clients. A four-week in-house educational class will soon be available for clients to sign-up as well. This is the American Cancer Society’s Fresh Start program, often only available through community organizations/hospitals. To assist with staff training, a PowerPoint Training on Tobacco Treatment has recently been developed. The training may be used to educate staff about the harmful effects of smoking and some of the resources that are available to help both clients and staff to be able to quit and/or reduce smoking. The PowerPoint Training was adapted from information developed by the University of Colorado, School of Medicine in Denver, Colorado, and consists of 37 slides with additional commentary. Any manager or staff within the agency can use the PowerPoint in providing educational information to both clinical and non-clinical staff. We have also included a short quiz to track training completion.
The new Tobacco Treatment training has been posted on the Home Page of out Intranet Site under a new header called “Trainings”. Members of the Committee may also be available to consult with program managers if they are in need of assistance with this training or need further support in resolving local problems at the program level.
The current members of the committee are; Bill Fagginger-Auer, Rachel Corbett Lavallee, Kitty Wilson, Susan Loynd, Cathy Chafin, Diane Thompson, and Lynn Jones. Feel free to be in touch with any committee member for more information on available resources and support. We thank all of you for your hard work and dedication towards the success of this transition. For more information please contact Rachel Lavallee or Bill Fagginger-Auer by agency email.
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