SCIMITAR+: a definitive RCT of a smoking cessation intervention for people with severe mental ill health Emily Peckham

Today’s Talk Background The SCIMITAR programme of work The bespoke smoking cessation (BSC) intervention Key findings The future

Are people with SMI interested in quitting smoking? Myth People who use mental health services aren’t interested in quitting. Reality In our survey of 3600 people with severe mental ill health: 45% of people said that they smoked 55% of those who smoked said that they wanted to cut down or quit smoking https://www.york.ac.uk/healthsciences/research/mental-health/projects/lifestylehealthandwellbeingsurvey/

Aims of the systematic review People with SMI are more likely to smoke and to smoke more heavily than those in the general population. It is important that effective interventions are implemented to help this disadvantaged group. The aims of the review were therefore: To assess the clinical effectiveness of smoking cessation strategies in people with SMI To assess the cost effectiveness of smoking cessation strategies in people with SMI Peckham, E., Brabyn, S., Cook L., Tew, G. & Gilbody, S., 2017. Smoking cessation in severe mental ill health: what works? An updated systematic review and meta-analysis. BMC Psychiatry, 17, 252

What works? The same things that work for the general population can work for people with SMI If participants were psychiatrically stable at initiation of quit attempts, smoking cessation interventions did not worsen their mental state. In addition a recent systematic review found no increase in psychiatric symptoms in participants prescribed varenicline1 1. Wu, Q., Gilbody, S., Peckham, E., Brabyn, S., and Parrott, S. (2016) Varenicline for smoking cessation and reduction in people with severe mental illnesses: systematic review and meta-analysis. Addiction, 111: 1554–1567. doi: 10.1111/add.13415.

Purpose of the SCIMITAR pilot Develop and test the intervention Learn about recruitment, randomisation and retention Establish the parameters for the full trial Preliminary estimates of effect

Who took part in the pilot? 97 People with SMI Long history of smoking – 27 years Heavy smokers – 25/day (range 5-60) Overweight BMI - 29

Findings from the SCIMITAR pilot: Why do people smoke? In the general population the most commonly reported motives for smoking were enjoying smoking and stress relief (Fidler & West 2009) In the SCIMITAR pilot study the three most commonly reported reasons were: ‘It helps me to cope with stress’(94%) ‘it helps me to relax’ (91%) and ‘it is something to do when I am bored’ (86%) Peckham, E., Bradshaw, T. J., Brabyn, S., Knowles, S. and Gilbody, S. (2016), Exploring why people with SMI smoke and why they may want to quit: baseline data from the SCIMITAR RCT. J Psychiatr Ment Health Nurs, 23: 282–289. doi:10.1111/jpm.12241

Findings from the SCIMITAR pilot: Why did people want to quit? 97% of participants said they wanted to give up because smoking was bad for their health compared to 83% in the general population 83% of SCIMITAR participants cited the expense of smoking as being an important reason for giving up compared to only 31% of the general population

SCIMITAR+ full trial Recruitment commenced October 2015 23 sites Recruiting in primary and secondary care Target recruitment of 400 Recruitment closed December 2016 526 people recruited Peckham, E, Arundel, C, Bailey, D, Brownings, S, Fairhurst, C, Heron, P, et al., 2017. Smoking Cessation Intervention for Severe Mental Ill Health Trial (SCIMITAR+): study protocol for a randomised controlled trial. Trials. 18(1):44

Target versus actual recruitment Original recruitment target was 400 participants This was achieved, earlier than anticipated, in October 2016 Agreed to continue recruiting to end of December 2016 Actual final recruitment = 526 participants 265 to BSC 261 to Usual Care

SCIMITAR+ intervention Flexibility on quit date Abrupt quit Cut down to quit Venue NRT support Number of sessions Support pack

Intervention summary 265 people randomised to receive the intervention 248 had at least one session 57 Mental Health Smoking Cessation practitioners (MH-SCPs) MH-SCP caseload between 1-17 participants Mean caseload = 4 participants 58% of MH-SCPs had three or more participants

How has SCIMITAR changed my life? I do discuss much more smoking cessation with patients and now I have the skills do find myself actually offering the support even though this is outside my current role. I can also support my team in doing this. We have had great success with E cigarettes and we hope this continues. I do think some people need quite some time and possibly ongoing support to stop so if all care coordinators or support workers could offer this it would be really beneficial

I am really hopeful that SCIMITAR will help change services as there is still an issue with provision of NRT in my area and Champix (Varenicline) is still contraindicated. I think that although stop smoking services do acknowledge people require more support I think the evidence around mental health professionals delivering this and hopefully funding for more NRT/ Champix will be useful

it’s been a very positive experience for me. I have contributed to delivering Level 1 Smoking Cessation training to inpatients services and community MH teams in Herefordshire We plan to roll out an e-learning option and the opportunity to train at Level 2 for staff I’m also on the on-going Smoke Free Project Board

SCIMITAR+ Experience Participant video

Conclusions Many people with SMI are concerned about the effects of smoking on their health and finances and would like to quit The same strategies that work in the general population appear to work in people with SMI. However significant barriers still remain to people with SMI accessing these interventions There is a need for studies exploring the effectiveness of e-cigarettes in helping people with SMI to stop smoking

Any Questions? Emily.Peckham@York.ac.uk This project was funded by the National Institute for Health Research Health Technology Assessment (project number 11/136/52)  The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Health Technology Assessment programme, NIHR, NHS or the Department of Health.