Staff experiences of tobacco dependency services for people with severe mental illness: an evaluation of community-based early-implementer sites

Background/Aims People with severe mental illness are more likely to smoke and less likely to access tobacco dependency services than the general population, contributing to physical health inequalities. This evaluation explored staff experiences of implementing and delivering community tobacco dependency services for people with severe mental illness. Methods Participants were recruited from early-implementer sites that delivered specialised tobacco dependency services for people with severe mental illness in the community. A total of 13 people participated, of whom nine were treatment providers and four were referrers, from four of the seven early-implementer sites. Data were collected through semi-structured interviews, which were transcribed and analysed using framework analysis. Results Six main themes were identified: importance of flexibility; the severe mental illness population; team communication and collaboration; reducing health inequalities; training and expertise; and setting up the service. Flexibility, communication and training were all seen as important enabling factors for this kind of service. Participants felt that clinicians who did not have a mental health background could deliver the service, as long as they received adequate training in severe mental illness. Conclusions Flexible, person-centred approaches to service provision can enable access and engagement among patients with severe mental illness. Effective team collaboration and communication, adequate training opportunities and sufficient time to establish teams and protocols are important for service implementation. Implications for practice Training for new staff is crucial for this kind of specialised service and could help with recruitment. Development of a referral model that facilitates ongoing communication and exchange of knowledge is also an important consideration for future services. The learning from this approach could inform service provision for other vulnerable or marginalised populations with complex needs.