1. A systems-based approach to reduce smoking rates among people living with serious mental illness in the Capital District community

2. Project Overview Urgency of need Unique challenges Benefits of improving BH response What do we do? How do we do it? Framework for Tobacco-Free Organizational Change Why now?

3. Urgency of Need “We need to quit. We really do. It’s expensive, it’s bad for our health, it’s killing us. I know that there’s all these studies that show that we die 25 years younger than the general population, and I think smoking certainly is one of those factors.” Testimony from HelpUsQuit.org http://www.ctri.wisc.edu/HC.Providers/healthcare_mental.health.htm http://www.ctri.wisc.edu/HC.Providers/healthcare_mental.health.htm Smoking Prevalence by Self-Reported Mental Health Status 2000-2001 and 2008-2009, NYS BRFSS

4. Unique Challenges Pharmacological interactions between tobacco smoke and medications History of social acceptability of tobacco use within mental health settings Higher than average smoking rate of behavioral health staff Persistent and inaccurate belief that tobacco use helps to alleviate anxiety, sadness and agitation Common belief among some providers and patients that successfully quitting smoking among people living with SMI is too difficult to achieve

5. Benefits of Improved Response Saves lives Saves healthcare dollars Improves productivity Nicotine Dependence is a DSM-IV Disorder Tobacco dependence and mental illness are co-occurring disorders Behavioral practitioners practice psycho-social treatments Consistent with wellness and recovery approaches Reimbursement for treatment is improving Williams, MD and Zeidonis, MD 2006

6. What Do We Do? Elevate tobacco use as a priority for people living with mental illness Integrate responses to tobacco use in assessment, intervention and treatment Create an environment that supports tobacco-free living for both employees and consumers

7. How Do We Do It? Plan Implement Sustain Elevate tobacco use as area of concern Educate agency staff, consumers, board Identify internal resources and strengths Identify needs Integrate tobacco use responses Increase/improve capacity of BH providers to respond effectively to tobacco dependence Revise policy and practices to include tobacco dependence assessment, intervention and treatment Create supportive environment Make grounds tobacco-free Maximize incentives and access to cessation resources

8. Framework for Tobacco-Free Organizational Change DODON’T

9. Community Health Improvement Plan workgroups in Albany, Schenectady, and Rensselaer identified tobacco use among people living with mental illness as priority target objective DSRIP - SPHP/Ellis have identified tobacco use among those living with mental illness as priority NYS OMH is currently in process of making all state-run BH agencies tobacco-free Capital District Tobacco-Free Coalition and Tobacco Cessation in Health Systems Program initiated collaboration of BH agencies in tri-county area Why Now? Substantial resources are currently available to guide us through this process

10. Available Resources NYS Office of Mental Health Access to online Tobacco Dependence Trainings through The Center for Practice Innovations (CPI) at Columbia University Opportunity to attain The Integrated Mental Health/Addictions Treatment Training Certificate from CPI at Columbia University Technical assistance from Adult Services, NYSOMH Opportunity to improve the lengths of Operating Certificates by achieving exemplary ratings on the Clinic Standards Capital District Tobacco-Free Coalition & Center for Smoking Cessation Coordination of regular meetings and activities to advance the goals of the Initiative Telephone, email or in-person technical assistance Provision of on-site training to mental health care providers on evidence-based interventions Provision of supportive materials and resources for both staff and consumers of service Hosting of centralized online resource for Initiative-specific documents, resources, and activities Sample policies, sample employee/consumer outreach materials, FAQs and timelines No-cost tobacco-free signage for your property Coordination of regional earned media and events regarding Initiative, including kick-off event or press conference as determined by participating agencies

11. Progress to Date ACMDH Comprehensive tobacco screening integrated into intake and treatment Staff trained on evidence-based best practices Established workgroup committed to addressing tobacco use at their facility Tobacco-Free grounds will be dependent upon county-wide decision to implement policy RCDMH Clinic staff trained on evidence-based best practices Discussion of improving signage and strengthening tobacco-free grounds policy Equinox, Inc. Making out-patient clinic grounds tobacco-free as of February 14, 2015 Working to improve access to cessation information and resources Established workgroup committed to addressing tobacco use at their facility Staff trained on evidence-based best practices Rehabilitation Support Services Actively engaged in addressing tobacco use among client population Working towards one or two facilities going tobacco-free initially, with others to follow

12. Progress to Date Northeast Career Planning Committed to going tobacco-free (no concrete date yet) Staff trained on evidence based best practices Established workgroup committed to addressing tobacco use at their facility Active Cessation group within PROS program Unity House Plans to make new Community Services Program building grounds tobacco-free Participating in local DSRIP workgroup focused on promoting cessation in MH population Ellis Hospital Mental Health (Schenectady) Actively engaged in bolstering tobacco-free grounds policy and increasing access to cessation resources and support Staff trained on evidence-based best practices Active cessation group within PROS program Homeless and Travelers Aid Society Early stages of determining how our efforts can be integrated into their services