Nearly 70 percent of individuals with serious mental illness (SMI), as compared with 23 percent of the general population, smoke cigarettes. Smokers with SMI and addiction consume nearly half of all cigarettes sold in the United States. Individuals

A project conducted by healthcare professionals at Clubhouse of Suffolk, Inc., a private, not-for-profit, psychiatric rehabilitation agency in New York, has found compelling evidence that these individuals respond to tailored interventions which address their specific needs. The project, which consisted of 57 Clubhouse members over the duration of one year, was funded by the New York State Department of Health, Tobacco Control Program. In October 2003, Clubhouse was awarded a grant to address the special needs of patients who struggle with tobacco addiction. The Clubhouse Project reveals that even a small reduction in smoking in this population will demonstrate favorable health outcomes as well as a cost-savings to State Medicaid expenditures. The findings were documented in a video, "Smoke Alarm: The Truth about Smoking and Mental Illness." In a pilot study, this model which included staff development/training, individual and group psycho-educational treatment and coordination of pharmacological treatment, had a significant impact on the readiness of participants to quit smoking, the number of cigarettes smoked per day (6.8cpd reduction), and the number of participants who made a quit attempt (36%). The Smoking Cessation Project at Clubhouse addressed the unique issues of tobacco use within this population and outlines the model which was developed and applied: a comprehensive approach addressing the biological, psychological and social aspects of tobacco dependence in individuals with mental illness. Initial plans for smoking cessation included assessing all members for tobacco use, developing strategies for working with smokers less motivated to quit, and providing action-oriented treatment for those ready to quit. The team spearheading the program developed health fairs and educational events for Clubhouse members. An eight-session wellness curriculum was implemented that covered nutrition, exercise, and information about tobacco. This strategy increased the involvement of smokers less motivated to quit and also linked smoking cessation to other activities promoting healthy lifestyles. Many members graduated from the wellness curriculum into smoking cessation classes, creating a continuum of services. In the summer of 2004, nine months after the program started, Clubhouse members (both smokers and non-smokers) decided to restrict outdoor smoking to certain areas and to prohibit smoking near the entrances pf the building. Two peer leaders who had been smoke free for at least six months were hired to supplement program staff efforts. They provided additional support to members who had recently quit smoking through daily phone calls and support groups. The program staff facilitated tobacco cessation groups that were held twice a week for eight-week cycles that repeated continuously for more than a year. Members benefited from education, ongoing support and additional individual counseling sessions. Staff helped clubhouse members access tobacco treatment medications from off-site psychiatrists and primary care physicians. Clubhouse members who used pharmacotherapy were more successful in quitting. This project also sought to reshape the culture of nearby mental health facilities. A tobacco advisory board with clubhouse administrative staff, key stakeholders, and local community providers was developed. The board was essential in helping identify and resolve potential barriers to program implementation. The healthcare professionals that created the Smoking Cessation Project at Clubhouse include: Jill Williams, M.D., is an Associate Professor of Psychiatry and Director of Mental Health Tobacco Services at the UMDNJ-Robert Wood Johnson Medical School. Dr. Williams specializes in the treatment of tobacco dependence in mentally ill populations. Bernadette W. Cain, M.B. A., the Project Director of the Smoking Cessation Project of Clubhouse of Suffolk. She is currently the Training Director of the Tobacco and Mental Health Training Project funded by NYS, DOH, Tobacco Control Program (TCP). Mary O'Shaughnessy, Psy.D, N.P.P., is a Psychiatric Nurse Practitioner and Professor of Nursing at Molloy College in New York. Tara Fredericks, LMSW, Clinical Coordinator of the Smoking Cessation Program, is currently the Project Director of Tobacco and Mental Health Training Project. New York State Department of Health

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