Mental Health Units Target Tobacco Use

July 7, 2008
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GRAND RAPIDS — Two local mental health hospitals went tobacco-free on July 1, a unique challenge for an area of health care that long carried a benevolent view of cigarette smoking.

Yet smoking and mental illness are symbiotic partners: A 2000 study in the Journal of the American Medical Association estimated that Americans with a mental illness diagnosis smoke cigarettes at twice the rate of the general population. Forty-four percent of cigarettes are consumed by the mentally ill, the study showed. For example, 1.6 percent of the population reported a bipolar diagnosis, and nearly 70 percent of them were smokers.

“Historically, patients at behavioral health and substance use treatment facilities have allowed smoking because it was not viewed as a ‘crisis’ illness, so this will be quite a change,” said Pine Rest Christian Mental Health Services Director of Admissions Jim Bottenhorn.

The result has been a higher rate of smoking-related illnesses for people seeking mental health treatment, said Doug Vance, Pine Rest vice president of general services.

“It really comes out of society’s interest in moving toward a smoke-free community,” Vance said. “Certainly we are following up on some of the acute care hospitals who had the initiative a couple of years ago.”

With a large proportion of crossover patients, Pine Rest and Forest View Hospital are implementing the policies in tandem, said Emily Quinn-Nausadis, director of community relations at Forest View. The united front also will prevent patients from choosing one over the other based on the option to smoke, she added. Pine Rest has 86 beds for adult inpatient and partial hospitalization, while Forest View has 40.

“The challenge, obviously, is that patients do have the opportunity to smoke throughout the day,” Quinn-Nausadis said. “They feel it’s a way for them to relax and cope.”

The hospitals now will expect patients to refrain from smoking during their inpatient stays. They will be offered prescription tobacco-replacement patches and medicine, hospital representatives said. Alternative activities will be increased to help patients deal with cravings. The average length of stay is eight to 10 days.

Staff members have been educating patients about the tobacco-mental illness link during group sessions, Bottenhorn said.

“The patients were surprised at some of the statistics that are out there,” he said. “One of the statistics is that 75 percent of people with an addiction or mental illness smoke, compared to 22 percent of the general population. And schizophrenics spent 27 percent of their income on tobacco.

“We’re really planting some seeds. When people are faced with some of those facts, they’re thinking about it.”

The policy also affects the 1,200 employees at the nonprofit Pine Rest and the 180 employees at Forest View. 

“This is really consistent with our whole interest in promoting wellness as employers and supporting employees and their families in making good lifestyle choices,” Vance said. “We want to follow that up with programming and assistance to help those who really want to change finally be successful with that.”

Pine Rest had been restricting smoking to designated areas on its Cutlerville campus, and other facilities, such as substance use disorder treatment programs, already prohibit smoking. The hospital displayed posters, designed by its marketing department, counting down the days until July 1. A task force has been brainstorming ways to help patients through tobacco withdrawal symptoms. It also has been working with tobacco cessation consultant Murray Kelly of the University of Florida.

At Forest View, owned by Universal Health Service Inc., a public company in Pennsylvania, a committee has been set up to explore issues around the new policy, Quinn-Nausadis said.

“Our CEO has committed to pay for smoking cessation for staff for six months — patch and medication,” Quinn-Nausadis said. “He is committed to doing that for people who do want to quit.

“It’s very much a supportive environment. We are not by any means expecting everyone to quit smoking.”

“We cannot continue to feed an addiction that is even worse in its medical and financial consequences than even alcohol,” added Dr. Stan Gunadi, Forest View medical director.

“Our goal is to deal with a special problem for people with mental illnesses and/or addictive disorders, and that is the unbelievably high rate of smoking in the population, which seriously complicates both treatment and recovery, and ultimately leads to other chronic illnesses and premature death,” said Mark Witte, population services manager for network 180, which provides emergency mental health services in Kent County.

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