“Everyone is very sensitive…”: Mental health professional perspectives of addressing tobacco use with consumers

The San Mateo County (California) Health System supports smoke-free living for mental health and substance use consumers. An online 12-item survey was completed by 92 mental health/substance use professionals, covering tobacco assessment practices, clinician knowledge and attitudes about tobacco use treatment, and readiness to integrate tobacco treatment into existing services.

Survey results show that 46% of clinicians always assess tobacco. Most report they have treated tobacco use at some point, while 26% have not. A strong majority of respondents (84%) said it was important to treat tobacco.

Regarding ability, only 4% of respondents were very confident that they could effectively treat tobacco use, while another 38% were somewhat confident. Less than half of clinicians felt confident in their knowledge of quitting aids and resources to help clients.

Respondents identified potential barriers to integrating tobacco treatment into their mental health and substance use treatment plans: 80% said their clients are not interested; 64% reported tobacco was less a priority than other issues; and 49% pointed to inadequate training.

Other barriers included tobacco being seen as a lower priority, nicotine being perceived as “helping” symptoms, and several clinicians reporting being unwilling to address tobacco if clients didn't bring it up themselves. Clinicians had several suggestions for integrating treatment, including frequent cessation classes, implementing a reward system, developing a laid-back approach, and establishing tobacco use parity with other addictions.

Our system is developing training for peer-to-peer cessation. Future trainings will ensure clinicians can assess, advise, and support smoke-free living among their clients.