Who is East Metropolitan Health Service?
East Metropolitan Health Service (EMHS) is an extensive hospital and health service network that aims to maintain and improve the health and wellbeing of West Australians. A range of services comprise the EMHS which reaches approximately 749,000 West Australians within a catchment area of 3,647 square kilometres.
The Royal Perth Bentley Group Community Mental Health Services form part of the EMHS, caring for 2,707 consumers between 2021-2022.
City East Community Mental Health Service (CECMHS) and Midland Adult Community Mental Health Service (MACMHS) are two community mental health services that form part of the Royal Perth Bentley Group. These services offer a multi-disciplinary range of care options for the consumer and their families such as psychiatrists, nurses and allied health staff to support a consumer’s recovery.
In 2019, Make Smoking History partnered with the Health Promotion team within Community and Population Health at EMHS to work with CECMHS and MACMHS to support outpatients to be smoke-free through implementing a Make Smoking History (MSH) project. The project aimed to increase the proportion of mental health consumers who have their nicotine dependency effectively managed and increase the proportion of staff who abstain from smoking whilst at work.
How this project helped EMHS achieve their mission and vision
The EMHS vision is for healthy people and amazing care. On top of this, the goals of EMHS include ensuring a safe and supportive workplace for staff and ensuring people accessing the services receive individualised care that leads to better health outcomes. Undertaking a MSH project helped achieve this vision by supporting consumers and staff to quit smoking in a healthy, smoke-free environment.
People living with a mental illness are significantly impacted by higher tobacco use. They are just as motivated to quit as the general population, but often face additional barriers that make it harder to reduce or quit smoking. This is why mental health services like CECMHS and MACMHS have an important role to play in connecting consumers with support to reduce and quit their smoking.
What difference has the project made for
Mental health consumers
As a result of the project consumers accessing CECMHS and MACMHS can now receive support to reduce and quit their smoking. This has been achieved by incorporating smoking status and brief advice questions into the WA Health Mental Health Assessment form and developing two new resources to assist staff when talking to consumers about their smoking.
Staff
The project supported staff to feel more confident in supporting consumers to address their smoking. This was achieved by staff receiving training in smoking cessation brief advice. The training included background information on smoking and mental health, the Ask Advise Help (AAH) brief advice model, and Nicotine Replacement Therapy (NRT). With improved accessibility and promotion of the staff NRT program, a group of staff from MACMHS supported each other to stop smoking and several staff reported that there were some successful quit attempts.
“Significant numbers of staff have stopped smoking in the last 2 years. The quit smoking program with free NRT worked well for staff.”
“Much less staff now smoke.”
“Have noticed a reduction amongst staff.”
Greatest learnings and achievements
The project lead from the Health Promotion team at EMHS said that the project was very appropriate for the services and that they were very satisfied with the project support provided by the MSH team.
“East Metropolitan Health Service Health Promotion has produced valuable outcomes in partnership with Make Smoking History in the last two years. The team value their ongoing expert support and advice to create effective smoke-free initiatives for our community.”
Key positive outcomes of this project included:
· The addition of smoking on the agenda for all their monthly team meetings at CECMHS.
· The inclusion of smoking status and provision of brief advice on the WA Health, state-wide, Mental Health Assessment form.
· Development of resources to help staff when talking to consumers about their smoking.
· The provision of training to build the capacity of staff to feel confident to support consumers with addressing their smoking.
Project Plan
Click on each of the priority areas below to find out what was achieved by CECMHS and MACMHS.
Implement and promote a comprehensive smoking policy
At the beginning of this project, EMHS already had a comprehensive smoke-free policy so this was not a focus of the project. The EMHS Smoke Free Policy aligns with the Smoke Free WA Health System Policy, updated as of July 2021.
Promote a smoke-free culture
· CECMHS and MACMHS established smoke-free working groups. The working groups helped to identify local issues and solutions.
· At MACMHS, the staff NRT program was promoted, and a new procedure was put into place to streamline how staff from MACMHS can access the program from the off-site pharmacy.
Expand smoke free environments
This outcome was not a focus of the project as the EMHS Smoke Free Policy already requires all sites to be smoke-free.
Build capacity and confidence of staff to address smoking
· Staff training was conducted at both project sites. The training included background information on smoking and mental health, the AAH brief advice model, and NRT and interactions.
· Two new resources were also developed for both project sites to assist staff when talking to consumers about their smoking.
Embed quit smoking support into processes and procedures
Extensive internal advocacy work resulted in a change to the WA Health, state-wide, Mental Health Assessment form. The form now has a specific question prompt around smoking status and the provision of brief advice.
Monitor and evaluate provision of quit smoking support
As part of the monitoring and evaluation of the project, pre-and post-project surveys were completed by staff at both project sites to assess staff members’ perceptions of the prevalence of smoking within their workplace, their role and their service’s role in assisting their clients to reduce or quit smoking, and the support available to them to promote smoking cessation. Further, pre-and post-patient file audits were also conducted to assess any changes in asking and recording of smoking status and support provided.