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Taking Issue   |    
The Need to Prioritize Smoking Cessation
Seth Himelhoch, M.D., M.P.H.
Psychiatric Services 2012; doi: 10.1176/appi.ps.20120p303
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Department of Psychiatry, University of Maryland School of Medicine, Baltimore

Copyright © 2012 by the American Psychiatric Association.

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Efforts to change the system and culture of mental health care to focus on the provision of smoking cessation interventions for people with mental illness are urgently needed. The Department of Veterans Affairs health care system (VA) is clearly leading the way in addressing this need. As reported in this issue, a study by Duffy and colleagues conducted in VA primary care treatment settings found that 80% of veterans with mental illness who described themselves as current or former smokers received advice from their physicians to quit smoking. Remarkably, veterans with mental illness were, in general, as likely as those without mental illness to report receiving aids to quit smoking.

Although the study has some limitations, it offers an example of a system of care that has succeeded in prioritizing smoking cessation and implementing cessation interventions in routine primary care. Clearly, making these changes is not an easy task. It requires leadership that enforces performance standards, technology that can provide automated clinical reminders, and reimbursement systems that reward providers and effectively make treatment for consumers free.

Although the VA system has prioritized the implementation of smoking cessation interventions, introducing similar practices in other mental health systems remains a challenge. One surmountable barrier is the historical reluctance of mental health clinicians to provide smoking cessation interventions to their patients who smoke. This reluctance is often attributed to the belief that patients with mental illness are less likely to want to quit smoking than those without mental illness and that smoking cessation interventions are ineffective. Both of these beliefs are largely unfounded. Also, administrators of mental health clinics may be reluctant to encourage provision of such interventions because of concerns about limited resources, inadequate reimbursement, and competing demands on clinician time. Mitigating these factors are changes in the reimbursement structure that are included in the Affordable Care Act and free and accessible state-sponsored smoking cessation resources, such as telephone quit lines.

More than ever, mental health care providers must come to terms with the fact that smoking has reached epidemic proportions among their patients. They must recognize that there is a clear confluence of evidence and policy that makes smoking cessation interventions affordable, accessible, and effective for their patients who smoke. The risk associated with maintaining the status quo is no longer acceptable, and bold steps are needed to ensure that smoking cessation interventions are consistently provided to patients with mental illness who smoke. The lives of our patients depend on it.

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