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

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

3. 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

4. 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., Smoking cessation in severe mental ill health: what works? An updated systematic review and meta-analysis. BMC Psychiatry, 17, 252

5. 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:  /add

6. 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

7. 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

8. 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: /jpm.12241

9. 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

10. 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., Smoking Cessation Intervention for Severe Mental Ill Health Trial (SCIMITAR+): study protocol for a randomised controlled trial. Trials. 18(1):44

11. 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

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

13. 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

14. 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

15. 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

16. 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

17. SCIMITAR+ Experience
Participant video

18. 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

19. 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.