May 31st was World No Tobacco Day as the World Health Organization put the spotlight on tobacco harms -- and advocated for policies to reduce consumption. Last week we profiled new research on electronic cigarettes. This article focuses on CAMH’s lead role in establishing a tobacco-free policy for clients and staff.
Spring 2015 marks a special anniversary -- it’s been just over a year since CAMH declared its hospital sites and campus completely tobacco-free.
Despite some pushback and fears of revolt, “this change has been welcomed by the majority of our staff and clients,” says Lilian Riad-Allen, Project Manager, CAMH Tobacco-Free Initiative. “We’re using a care approach rather than an enforcement approach.”
“With our new clinical information system, every single inpatient client admitted to CAMH is now screened for tobacco use,” notes Lilian. Those who smoke are offered nicotine replacement therapy either as a cessation aid or for temporary withdrawal management.
Last year, on April 30th, 2014, lockers used to store client cigarettes onsite at CAMH inpatient units were decommissioned. Meanwhile, on-site education was ramped up, delivered by the hospital’s roving First Impressions Community Ambassadors. CAMH had previously eliminated designated smoking areas.
Lilian Riad-Allen: Making the case for tobacco-free
Opponents might say CAMH is too aggressive in its stance, but there’s a powerful case for tobacco-free, says Lilian:
- CAMH is confronting the leading cause of preventable death -- tobacco use cuts 13-14 years off the life of a client, on average
- Research shows tobacco cessation enhances a client’s success in recovery from mental illness
- A tobacco-free site eliminates powerful triggers for clients and staff who are trying to quit or stay quit
- The policy eliminates harms from second-hand smoke.
One CAMH client summed it up this way: “As a consumer/survivor on a limited income, quitting is the single most liberating thing I’ve been able to do for myself in decades. I thought I was going to die as a smoker, and because of smoking. I didn’t want to have to tell my kid that.”
Another said: “To be able to come here and be met with clean air makes me feel more comfortable.”
Positive results in first year
Lilian notes several emerging positive impacts from CAMH’s tobacco-free policy, including changing attitudes.
A survey of clients found 71 per cent supported the tobacco-free policy following the launch, compared to 59 per cent pre-launch. In addition, 76 per cent said they would add to the success of the policy by not smoking on CAMH property, versus 69 per cent pre-launch.
Sandra Cushing is co-lead of the CAMH initiative on Integrating Smoking Cessation into Daily Practice, a key component of CAMH’s designation as a Best Practice Spotlight Organization (BPSO).
“Our results to date show increased screening of clients and more use of nicotine replacement therapy products such as the nicotine inhaler,” says Sandra. Results will be quantified as additional reporting tools are added to CAMH’s clinical information system.
She notes the important role of CAMH clients in the cessation initiative. “They provided open and honest feedback to our two pilot teams about their journey with tobacco – to try to quit or stay quit. They really brought the issue home to us.”
Sandra, an Advanced Practice Clinician, and her project co-lead, Kirstin Bindseil, discuss the cessation initiative in this CAMH video:
We’ve come a long way
“Many years ago, smoking was pervasive on client inpatient units, and cigarettes were used as a reward for patients,” says Dr. Peter Voore, Medical Director, Ambulatory Care and Structured Treatments. “That was a different time and our culture has moved on. Today, we recognize that the heavy smoking of a client with schizophrenia can cut many years off his or her life. We are taking a very active approach to smoking cessation for our clients.”
Dr. Peter Voore, Medical Director, Ambulatory Care and Structured Treatments
For Lilian, it’s also been a personal journey over the past two years, including how she first engaged clients on this issue.
“It can be difficult to have that conversation with a client who is smoking, but really it’s all about respect. I’ll ask them how they are doing. I’ll ask their permission to talk about the policy. Many clients will tell me: ‘I want to quit, and I support your policy.’”
Lilian also stressed the key role of all CAMH staff as ambassadors of the policy: “Our success to date with the new policy is your success -- thank you for helping make CAMH tobacco-free.”