Innovative telephone intervention encourages abstinence from tobacco use among people with mental disorders

A study led by the Tobacco Control Unit (UCT) of the Catalan Institute of Oncology (ICO), in collaboration with the Health Department of Catalonia and six hospitals in the province of Barcelona, has demonstrated the effectiveness of a proactive, motivational telephone intervention in getting patients with severe mental disorders to stop smoking. It is estimated that around 75% of patients hospitalised for mental illness smoke, which is three times the rate of smoking in the general population. People with mental disorders are more likely to smoke, and smoking is estimated to be the cause of death in between 48% and 53% of this group.

The research, published in the International Journal of Mental Health and Addiction, has demonstrated the effectiveness of a telephone smoking cessation intervention through the 061 CatSalut Respon line of the Generalitat de Catalunya’s Department of Health. This is the first study of its kind specifically designed for patients with mental disorders with a 12-month follow-up. The study included smokers with mental disorders admitted to the psychiatric wards of six acute hospitals in the province of Barcelona: Hospital Clínic, Hospital de la Santa Creu i Sant Pau, Hospital Universitari Vall d’Hebron, Hospital Universitari de Bellvitge, Hospital Hestia Duran i Reynals and Fundació Althaia.

The team of researchers from the ICO and the six hospitals mentioned above designed a telephone intervention with a proactive approach to help people with mental disorders admitted to hospital to quit smoking after discharge, taking advantage of their abstinence or reduction in consumption during their admission, as smoking is prohibited in acute hospitals and they receive help to remain abstinent. Depending on the case, the intervention aimed to increase motivation to quit, achieve abstinence, prevent relapse, reduce consumption or recommend pharmacological treatment.

The intervention was delivered by nurses trained in smoking cessation and care of people with mental disorders via the 061 CatSalut Respon telephone line. The clinical trial intervention group received a telephone call from the trained nurses within 48 hours, one week, 15 days and one, three, six and 12 months after discharge. Each call provided an intervention strategy tailored to the patient’s situation. Participants in the control group received only the initial smoking cessation advice and were asked the same variables to compare outcomes between groups.

During the calls, nurses helped participants in the intervention group to identify barriers and opportunities to quit smoking, set goals, and develop strategies to manage withdrawal or ‘mono’. The results suggest that smokers with severe mental disorders who stopped smoking while in hospital were more likely to quit successfully with the help of the telephone intervention. Other studies have found that patients with mental disorders who quit smoking reduce their anxiety, improve their quality of life and have better results in abstinence from other drugs.

The authors also suggest that this intervention could be transferred to routine clinical practice throughout the national health system. Cristina Martínez, lead author of the study and Deputy Head of the Tobacco Control Unit (TCU), emphasises that the study ‘demonstrates the acceptability and feasibility of this intervention and that tailored quitlines could be a community-wide solution to promote the benefits of smoking cessation during hospitalisation’.

This programme not only promises to significantly improve the quality of life of mentally ill people who smoke, but also to increase their life expectancy by reducing one of the most important risk factors for their health, smoking.