New Program Helps Homeless, Mental Health Patients Quit Smoking

[Thomas3.20.2010]

OTTAWA — When Derrek began turning his life around eight years ago he thought that drugs and alcohol would be the biggest demons he would have to face. Six years into his recovery he discovered there was one more addiction he needed to confront.

“I have beat alcohol addiction, I beat drug addiction, and I am not living on the street any more — but tobacco has me beat,” said Derrek, who is now two years smoke-free and is working as a smoking cessation counsellor. Derreck, who asked that his last name not be used, was a participant at a conference in Ottawa last week that tackled the difficult issue of smoking among the homeless and those suffering from psychiatric disorders.

There is a growing awareness in the health community that historical attitudes toward smoking when assisting patients with mental health problems and the homeless is unacceptable. Until recently medical health professionals worried that the strain of quitting smoking would be too much for patients. Many of these individuals were already dealing with addictions to other drugs or confronting their mental health problems and the added stress of quitting smoking seemed too much for these people to take on.

In fact, cigarettes were often used as rewards for good behaviour when patients followed institution rules or were agreeable to staff. Because of this, cigarettes became ingrained in the culture of homeless shelters and psychiatric centres across the country.

His personal experiences have given Derrek important insight on how to lead his smoking cessation support group for people recovering from other addictions. “I don’t know anybody living on the street, or who has lived on the street, where one of the major components of that wasn’t mental health,” said Derrek.

“I wanted to quit everything all at once when I went through rehab at the mission,” said Derrek “they told me no, that I may stress my body too much and have seizures from getting rid of everything immediately, but that I will know when I need to give up tobacco.”

“It’s very sad to look back and recognize what we use to do in those days,” said Dr. Andrew Pipe, chief of the Division of Prevention of Rehabilitation at the University of Ottawa Heart Institute, “it was very common for cigarettes to be used as a reward for patient compliance.” Cigarettes even provided what was perceived as a relief from symptoms for their users. “Unfortunately that relief is nowhere near what could be achieved by other, more appropriate treatment,” said Pipe.

According to Pipe, the life expectancy of someone with a psychiatric illness is 25 years less than that of other Canadians. The largest proportion of deaths in this discrepancy is accounted for by tobacco-related diseases such as cancer as well as lung and heart disease. In fact, smokers in Ottawa without adequate housing also run a much higher risk of getting pneumonia from the cold winter weather.

There is a growing awareness that this practice puts patients at risk. “Those attitudes are now changing dramatically as more psychiatric facilities go smoke free and recognize that the thing most likely to kill their patients is their tobacco addiction,” said Pipe.

When the Royal Ottawa Mental Health Centre polled their patients to see whether they were interested in quitting or cutting down their smoking, a staggering 79 per cent were interested. Because of this the Royal Ottawa went smoke-free in January of 2012.

Until this point the Royal Ottawa still permitted smoking within interior courtyards. This allowed patients who may not have had permission to leave the grounds of the hospital to continue to smoke. Under the Royal Ottawa’s new rules, these patients are now forced to quit, though they are given nicotine replacement therapy to help reduce withdrawal symptoms. Smoking cessation support groups like Derrek’s group have also been created to discuss the challenges of kicking the habit and offer assistance to patients.

“The groups that we facilitate give you all new coping mechanisms,” said Derrek “it’s a whole change in your demeanour, the way you carry yourself.”

This initiative, part of a new program from the Heart Institute, is known as the Ottawa Model and is being implemented across the country and receiving positive reviews from health-care professionals. Patients who wish to smoke but do not have the permission to leave the hospital are offered nicotine in patch, gum, lozenges and inhaler form. “You can be very successful in helping individuals addressing psychiatric challenges deal with their tobacco addiction by using many of the same principles and methods you would use in other settings,” said Pipe.

Dr. Jeff Turnbull is the chief of staff at the Ottawa Hospital as well as the medical director of the Ottawa Inner City Health Project. He is also raising awareness about the staggering rate of smokers in mental health facilities and homeless shelters. Turnbull points to environmental factors as the reason so many homeless individuals smoke.

“It’s a very stressful environment, the whole community around them smokes; it’s viewed as being a normal part of being homeless,” says Turnbull. “You have to change their culture if you want them to change”

According to Turnbull, nearly 100 per cent of chronically homeless in Ottawa smoke. He says this is due in part to the commoditization of cigarettes at shelters and on the streets. According to Turnbull, “the chaos that they live in on a daily basis it is very hard for them to quit smoking.”

So, when should someone that is dealing with these types of issues quit smoking? “The right time is when the individual has a stable environment, through initiatives like supportive housing, with all of the right supports around them, then you can put the (anti-smoking) systems in place,” says Turnbull.