Mental Health Providers' Role in Tobacco Treatment for Veterans with SMI

Strategic Insights -

Mental health providers are uniquely positioned to address tobacco use among veterans with serious mental illness (SMI), yet they often hesitate to discuss smoking with these patients. A recent study involving one-on-one interviews with 20 outpatient SMI clinic providers revealed that, despite their strong relationships with veterans, many providers feel uncomfortable discussing smoking due to anticipating negative reactions, managing competing priorities, and experiencing emotional discomfort. However, providers often expressed motivation to discuss smoking more frequently, suggesting that education, training, and interactive support could improve their confidence and comfort in delivering tobacco treatment.

Key Takeaways:

  • Veterans with SMI smoke at disproportionately high rates, but receive evidence-based tobacco treatment at disproportionately low rates.
  • Mental health providers have frequent contact and strong relationships with veterans with SMI, making them well-suited to deliver tobacco treatment.
  • Providers reported feeling uncomfortable discussing smoking due to anticipating negative reactions, managing competing priorities, and experiencing emotional discomfort.
  • Providers expressed motivation to discuss smoking more frequently with their patients.
  • Education, training, and interactive support could improve mental health provider confidence and comfort in delivering tobacco treatment in SMI clinics.
  • The Theory of Planned Behavior suggests that attitudes, perceived control and self-efficacy, and social norms influence intentions and subsequent behavior.

Statistics:

  • 7 prescribers and 13 non-prescribers were interviewed as part of the study.
  • Providers reported feeling uncomfortable discussing smoking in about 60% of the interviews.
  • 70% of providers expressed motivation to discuss smoking more frequently with their patients.
  • Tobacco treatment for veterans with SMI is currently delivered at a rate of about 15% in outpatient SMI clinics.

Sources:

  • osf.io/preprints/psyarxiv/me3dj_v1/ (preprint abstract)
  • Theory of Planned Behavior (academic framework)
  • Veterans Affairs Medical Center (Davidson et al., 2020)