In their quiet but powerful way, these intrepid advocates are devoting countless hours of effort to help people with mental health challenges see through the smoke of their cigarette use and lead a tobacco free lifestyle.  

Without any funding, they’ve cobbled together an impressive portfolio of resources, conducted workshops and presentations, and tried to get anyone who’ll listen to hear their message that life is much better without the butts.  What they’ve found is that amidst this daunting problem there’s hope for health.

They are the Smoking Cessation Support Initiative (SCSI), a group of individuals working in the fields of recovery, mental health, and substance abuse treatment. 

SCSI from left to right: Phyllis Freeman (Bridge House), Ingrid Gillespie (Lower Fairfield County Regional Action Council), Steve Bistran (advocate), Kim O’Rielly (Southwest Regional Mental Health Board), Kevin Kasbarian (Greater Bridgeport Area Prevention Program). Janine Sullivan-Wiley (Northwest Regional Mental Health Board) Not pictured: Paula Aspesi (FS DuBois Center)

Beginning in 2005, Kim O’Reilly, Executive Director of the Southwest Regional Mental Health Board, Ingrid Gillespie, Director of the Lower Fairfield County Regional Action Council, Janine Sullivan-Wiley, Executive Director of the Northwest Regional Mental Health Board, researchers and Mental Health leaders began pondering different ways to address why people living with serious mental illness and substance abuse smoke so much.

Too many lives lost

Research demonstrates that people living with mental illnesses die 25 years younger than the general population. This is largely due to preventable problems like smoking, the leading preventable cause of death in the United States that claims some 440,000 lives each year.  People living with serious mental illness have 2-4 times higher smoking rates than the general population according to the Oregon Health and Science University Smoking Cessation Center.  Nearly 41% of smokers, they say, report having a mental health diagnosis in the previous month.  Astonishingly, nearly 45% of all cigarettes sold in the US are purchased by people with either a mental illness or a substance use disorder, says the Smoking Cessation Leadership Center at the University of California in San Francisco. 

In 2009 the Leadership Center named the SCSI one of the ‘100 Pioneers’ in the nation who are taking the lead in tackling the problem of helping people with mental illness live a life without cigarettes.  The SCSI have developed exactly the type of transformation this public health crisis has needed for some time. 

As good a chance as anyone

The new school of thought in this grassroots endeavor is a simple one - people living with mental illness have as good a chance of quitting smoking as the general population. In fact, from 1991 to 1992 the National Comorbidity Survey (NCS) conducted a survey on 4411 respondents aged 15 to 54 years with no mental illness, a lifetime mental illness, and past-month mental illness. Smokers with any history of mental illness had a self-reported quit rate of 37.1%, and smokers with past-month mental illness had a quit rate of 30.5% compared with smokers without mental illness at 42.5%. The conclusion of the study was that persons with mental illness have substantial quit rates, similar to that of the general population.

For the mental health field, the idea of smoking cessation has been controversial, but that is slowly changing.  The quandary has been that cultural norms have dictated for decades the notion that mental health consumers need to use their nicotine addiction as a crutch or coping mechanism, and that with all the other issues they face, they cannot be expected to quit smoking as well.  Over the years, the treatment system has given tacit support for smoking so much that facing down and changing this culture has been a major element of SCSI’s work.

Gillespie, O’Rielly, and Sullivan-Wiley have compiled numerous studies, resources and ideas supporting the realization that many people with mental illness want to stop smoking.   Sadly, many clients aren’t ever asked if they want to try to lead a tobacco free life or if they need help to achieve it.

What the SCSI initiative has uncovered is that consumers of mental health services, much like those with substance use disorders, are not being considered for nicotine replacement therapy nor asked if they would like information and resources to help them quit.  Janine Sullivan-Wiley, passionate crusader for changing these norms surrounding this public health issue, says “We approach the client by giving them choices; we are not saying they have to quit, what we are saying is that they can if they want to and SCSI is here to help when they do.”

All three advocates think the key in helping consumers is both a ‘top down’ and ‘bottom up’ approach.  On one side, leaders can help shape the systems of care that support a smoke free lifestyle in both their clients and their staff.  Examples of this might be Connecticut’s newly established Medicaid reimbursement for smoking cessation medications or the new laws about prohibiting smoking in public places.  At the service level, counselors can begin the change process by simply asking whether their client has considered a smoke free future and knowing what resources exist that might help them.
What conclusions have these three educators reached?  First, much work needs to be done to change perceptions about consumers’ ability to quit while seeking treatment for their mental health.  Many want to quit.  Second, the benefits of becoming and staying smoke free have to be couched along a spectrum of motivations.  Taking ‘baby steps’ in a careful way needs to be offered and encouraged.  Third, advocacy work is needed at local and legislative levels to prove that people living with mental illness can live a life free from nicotine addiction. All they need is encouraging support and the tools to help prevent relapse.

Whether or not one has a mental illness, quitting smoking is HARD!  If you’d like information on smoking cessation assistance, please call the Connecticut Quitline at 866 END-HABIT
(866-363-4224).  They are available to assist you 24/7.