Rebecca Gordon writes:
Quitline Victoria’s successful model of collaborative care demonstrates that people with depression can quit smoking with the right support.
Research recently published in the Medical Journal of Australia evaluated a collaborative care model for smokers with depression run by Quitline Victoria.
It followed 227 Quitline clients with depression to measure uptake of a Quitline-doctor co-management model of smoking cessation as well as its impact on successful quitting.
There was strong support from those participating in the study, and 72 per cent made a quit attempt. Of those who talked to their doctor about quitting, co-management increased the likelihood of making a quit attempt. Importantly, quitting did not increase the risk of exacerbating depression (see the study for full details).
Quitline Victoria is the first Quitline in Australia with a tailored counselling protocol for smokers with a history of depression. In the co-management model, the client’s doctor manages any medication while Quitline provides call-back counselling tailored for people with depression and sends the doctor updates on progress, similar to specialist feedback.
About a quarter of people contacting Quitline disclose a mental health problem, most commonly depression. A key feature of the Victorian model is that it captures both those who first ask their doctor for support to quit and those who contact Quitline directly.
Co-management can be initiated either by fax-referral direct from a doctor, or by Quitline identifying a client with depression and sending them a fax-referral form to take to their doctor.
Smoking rates among people with mental illness are still well above rates in the general population. The belief that people with mental illness can’t quit, or don’t want to, has led to them not receiving the same support from health professionals that has helped drive smoking rates in the general population below 20 per cent.
Because of this, people with mental illness suffer a greater burden of smoking related ill health and financial strain exacerbating social disadvantage. It is only recently that action has been initiated to address this imbalance.
Quitline Victoria’s mental health policy recommends co-management for all clients with mental illness and has the potential to be adapted for other comorbidities as well as for other socially disadvantaged groups.
Many people quit unaided, but for those who need support, collaborative models of care that involve the client, health professionals and support services will contribute both to improving the quality of life of people with mental illness and to reducing social disadvantage.
This study adds to a growing body of research that shows people with mental illness want to and can quit, and health professionals can actively contribute to reducing social disadvantage by supporting them to do so.
• Rebecca Gordon is consultancy services manager at RaggAhmed. She currently manages a project with Cancer Council NSW and NSW Health around reducing smoking in mental health inpatients.
