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Tobacco dependency treatment services in severe mental illness

This evaluation aims to capture insights from seven early implementer sites about the commissioning and delivery of community-based tobacco dependency treatment services for people with severe mental illness.

Background

People with severe mental illness (SMI) have a life expectancy that is about 15-20 years shorter than in the general population. One important reason for this inequality in life expectancy is cigarette smoking. People with SMI tend to smoke more cigarettes daily than smokers without mental illness, and they are more likely to be cigarette smokers than the general population. As a result, people with SMI have a higher risk of developing smoking-related illnesses that impact their physical health.

People with SMI are motivated and able to stop smoking with the right support. However, the support offered in standard stop-smoking services – also called tobacco dependency treatment services – is often not appropriate. In April 2022, NHS England commissioned seven early implementer sites to deliver community-based tobacco dependency treatment services specifically designed to support people with SMI.

In this evaluation, we aim to find out how tobacco dependency treatment services for people with SMI are being delivered in the early implementer sites. Specifically, we aim to understand:

  1. How the tobacco dependency treatment services are organised and delivered to support the needs of people with SMI.
  2. How people are referred into the service, and how referral pathways have changed over time.
  3. How success of the tobacco dependency treatment services is defined and measured locally, and what measurement challenges are encountered.
  4. If locally available, what costs are associated with the delivery of the tobacco dependency treatment services, and how the services are currently funded.

Approach

Our evaluation approach was informed by scoping work, which is summarised. The evaluation involves the following work packages:

Work package 1: Survey of commissioners and staff at early implementer sites

In each of the early implementer sites, we will ask tobacco dependency treatment service leads to circulate a short survey that is hosted on the Thiscovery platform. The survey will be circulated to commissioners, management and support staff, and stop-smoking practitioners involved in the early implementer site tobacco dependency treatment services. Survey questions focus on the way stop-smoking support is delivered in the service, how people are referred into the service, and how success of the service can be best captured.

Work package 2: Supplementary interviews in early implementer sites

We will go back to the tobacco dependency service leads (n=8) from the early implementer sites who we interviewed during our scoping work. Interviews will be arranged to discuss topics covered in the survey in greater detail. We will also ask interviewees about the available data on the costs associated with delivering the service, and how the service is funded. We will conduct additional interviews (n=7) with any key individuals identified by the service leads.

Work package 3: Wider stakeholder perspectives and contributions

3.1. Perspectives of people with lived experience of smoking and SMI.

We will hold 1-2 workshops with those with lived experience of SMI and smoking. In the workshops, we will share and discuss summary findings from work packages 1 and 2 to understand and capture the perspectives of people with lived experience of SMI. For example, do people with lived experience of SMI have similar or different views regarding ‘success’ of tobacco dependency treatment services and how success should be measured. We will also discuss the local service delivery models and referral pathways and reflect on their potential benefits and limitations from a service user perspective.

3.2. Perspectives of national stakeholders.

We will also hold a virtual workshop with staff from the early implementer sites and national stakeholders. We will share summary findings and discuss implications for the future provision of tobacco dependency treatment services for people with SMI. We will invite members of organisations consulted during our scoping work and some additional stakeholders.

Project team

  • Jenny Newbould (PI)
  • William Phillips
  • Jessica Dawney
  • Sophie Spitters
  • Helen Dent

Outputs

Results from this evaluation will be written up in a short report that is published in the NIHR Journals Library (HSDR programme) and made available on the BRACE website. We will also produce a summary policy briefing. A summary of our scoping work can be found.

Project Duration

November 2024 - April 2025