Tackling Tobacco in community mental health services: addressing tobacco use by people with severe mental illness through an organisational change framework

INTERVENTION: Services allocated to the intervention condition will receive a "high intensity" version of the Tackling Tobacco program. Tackling Tobacco is an organisational change based framework that seeks to enable organisations to address tobacco in a routine a comprehensive manner through changing culture, processes, systems and procedures. All intervention services will complete a pre‐project audit and project plan based on the guidelines for addressing tobacco in community mental health services. Project plans are comprised of the six elements of the Tackling Tobacco program and prompt services to review the Tacking Tobacco guidelines before setting the services unique goals. High intensity services will receive: ‐ dedicated support from a research team staff member with minimum 2 years experience in the tobacco control field. The dedicated support person will work with the service to implement the services project plan. ‐ a financial grant totalling $10,500 AUD to cover the costs of project plan implementation and cost of quit support (nicotine replacement therapy) ‐ access to staff training via Tackling Tobacco online training and a one day (6 hours) face to face training course. The online training course covers four modules and focuses on providing context for the need to offer smoking care to vulnerable populations, including people experiencing severe mental illness, how to deliver a brief intervention (based on the 5A's model), assess nicotine dependence and offer nicotine replacement therapy. The one day face to face training course provides an opportunity to practice skills building in delivering the 5A's including role playing and and to familiarise and increase knowledge of nicotine replacement therapy. The one day face to face session also provides an opportunity to brainstorm strategies to overcome barriers to implementing the service's project plans. ‐ written, printed resource packs (one per staff member attending training) which includ CONDITION: Mental Health ‐ Addiction Mental Health ‐ Schizophrenia Public Health ‐ Health promotion/education severe mental illness;tobacco use; ; severe mental illness ; tobacco use PRIMARY OUTCOME: Consumer's self report of being offered nicotine replacement therapy (gum, lozenge, patches, inhaler or mouth spray) by staff at their current community mental health service. This outcome will be assessed using a Y/N item in a written survey deigned specifically or this trial. [Six and nine month follow up post start of intervention implementation] SECONDARY OUTCOME: Consumer 7 day point prevalence abstinence both by self‐report and verified biochemically through carbon monoxide breath analysis. This outcome will be assessed using the "even a puff" criteria suggested by the Russell Standard (West et al, 2005) through written surveys designed specifically for this trial. ; [Six and nine month follow up post start of intervention implementation] Proportion of consumers with a self‐reported reduction in number of cigarettes smoked per day by at least 50%. This outcome is assessed using an item frequently used in tobacco cessation trials (On average, how many cigarettes do you smoke per day?") through written surveys designed specifically for this trial. [Six and nine month follow up post start of intervention implementation] Proportion of staff reporting 'always' completing steps of the 5As with consumers who smoke. This outcome will be assessed using written surveys designed specifically for this trial. [Six and nine month follow up post start of intervention implementation] INCLUSION CRITERIA: Key inclusion criteria for staff Aged 18 years or older Currently employed by the community mental health services participating in the trial Key inclusion criteria for consumers Aged 16 years or older Able to provide informed consent Current (daily or occasional) tobacco user Currently engaged with the participating community mental health service (note in order to qualify for support consumers must have a mental health diagnosis) Likely to still be engaged with the community mental health service in 12 months' time (i.e. not planning to be exited form the service in the next 12 months)