Systematic review and meta-analysis of the provision of preventive care for modifiable chronic disease risk behaviours by mental health services

People with mental illness experience increased chronic disease burden, contributed to by a greater prevalence of modifiable chronic disease risk behaviours. Policies recommend mental health services provide preventive care for such risk behaviours. Provision of such care has not previously been synthesised. This review assessed the provision of preventive care for modifiable chronic disease risk behaviours by mental health services. Four databases were searched from 2006 to 2017. Eligible studies were observational quantitative study designs conducted in mental health services, where preventive care was provided to clients for tobacco smoking, harmful alcohol consumption, inadequate nutrition, or inadequate physical activity. Two reviewers independently screened studies, conducted data extraction and critical appraisal. Results were pooled as proportions of clients receiving or clinicians providing preventive care using random effects meta-analyses, by risk behaviour and preventive care element (ask/assess, advise, assist, arrange). Subgroup analyses were conducted by mental health service type (inpatient, outpatient, other/multiple). Narrative synthesis was used where meta-analysis was not possible. Thirty-eight studies were included with 26 amenable to meta-analyses. Analyses revealed that rates of assessment were highest for smoking (78%, 95% confidence interval [CI]:59%–96%) and lowest for nutrition (17%, 95% CI:1%–35%); with variable rates of care provision for all behaviours, care elements, and across service types, with substantial heterogeneity across analyses. Findings indicated suboptimal and variable provision of preventive care for modifiable chronic disease risk behaviours in mental health services, but should be considered with caution due to the very low quality of cumulative evidence

Smoking cessation care for people with a mental illness: Family carer expectations of health and community services

Introduction: Smoking prevalence remains high among people with a mental illness, contributing to higher levels of morbidity and mortality. Health and community services are an opportune setting for the provision of smoking cessation care. Although family carers are acknowledged to play a critical role in supporting the care and assistance provided by such services to people with a mental illness, their expectations regarding the delivery of smoking cessation care have not been examined. Aims: To explore family carer expectations of smoking cessation care provision by four types of health services, to clients with a mental illness, and factors associated with expectations. Methods: A cross-sectional survey was conducted with carers of a person with a mental illness residing in New South Wales, Australia. Carers were surveyed regarding their expectations of smoking cessation care provision from four types of health services. Possible associations between carer expectation of smoking cessation care provision and socio-demographic and attitudinal variables were explored. Results: Of 144 carers, the majority of carers considered that smoking cessation care should be provided by: mental health hospitals (71.4%), community mental health services (78.0%), general practice (82.7%), and non-government organisations (56.6%). The factor most consistently related to expectation of care was a belief that smoking cessation could positively impact mental health. Conclusions: The majority of carers expected smoking cessation treatment to be provided by all services catering for people with a mental illness, reinforcing the appropriateness for such services to provide smoking cessation care for clients in an effective and systematic manner

Outpatient interventions for smoking cessation and reduction for adults with a mental disorder

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective of this review is to determine the effectiveness of smoking reduction and cessation interventions (alone, or in combination with other interventions), delivered primarily in an outpatient or community‐based setting among individuals with mental disorders, on rates of abstinence at the longest follow‐up (minimum six months), mental health symptoms and adverse events. Secondary objectives are to examine the impact of such interventions on rates of abstinence at the end of the intervention, change in daily cigarette consumption, and quality‐of‐life or other function scores. We will explore (via subgroup analyses) potential differential effects on the basis of intervention type, control group type, recruitment setting (inpatient versus outpatient), mental disorder type, and motivation to quit at study intake. We may come across studies testing interventions which aim to increase the uptake of smoking interventions in people with a mental disorder. This may comprise interventions that either are incorporated into the system of delivering care, aimed at health professionals (e.g. within a community mental health facility), as well as interventions aimed directly at people with a mental disorder to increase uptake. In this case we aim to examine whether these interventions increase the uptake of the smoking cessation treatment among people with a mental disorder, as well as whether they ultimately result in increased quit rates