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When Kent & Medway PCT asked for input from a vaper for their conference on smoking cessation within mental health facilities NNA trustee Sarah Jakes was only too happy to oblige. Here are Sarah's impressions of the day.

 Whilst I know quite a lot about vaping, the issues faced by the staff and users of mental health facilities was something very new to me, and it was a fascinating day. Smoking prevalence among those people with mental health issues is about 40% on average and some wards reported very much higher rates than that. Smoking inside facilities has been banned since 2008, and since then in many cases staff have had to accompany patients outside so that they can have their cigarette. There are now plans to ban smoking even from the grounds in some trust areas, which will no doubt be very distressing for patients and cause further problems for staff. 

After hearing presentations from a trust which had already successfully introduced e-cigarettes, and one that didn't intend to, Hazel Cheeseman of ASH London started off the main e-cigarette segment with a presentation of the facts and figures surrounding vaping in the UK derived from their own surveys and those of Public Health England and the Smoking Toolkit Study. I followed up with a presentation of what it is to be a vaper, and why it works for us. our presentations were followed by one from a pharmacist, who highlighted the particular difficulties of e-cigarette use in the mental health setting, to add a bit of the obligatory balance. 

The presentations seemed to go down very well, and I hope that the delegates found my input useful. I was asked to provide feedback to the conference organisers, which I will copy here as it gives a bit of insight into the day in general:

"I was shocked at the very high smoking rates some people were reporting from their wards, and at the fact that people were initiating or increasing their smoking after being admitted. That said, the reasons for it seem to make sense but it's a cycle that needs to be broken. So from what was said, it seems that you are dealing with people who have an equivalent motivation to quit as those in the general population, but are (and I know some slide or other said different) less likely to succeed long term without relapse. To me as a layman in this area that seems obvious - they're bored a lot of the time and have enough to worry about as it is, without losing something that is familiar and a comfort to them. To take it out of the MH context for a moment, when I smoked I would often seek to smoke if I found myself in unfamiliar or stressful circumstances, because smoking was a constant. It was an escape back to something I knew and understood, the friend that is always with you. I now have a new and much nicer friend!

It seems that some services are shackled by budgetary restrictions and whoever decides their budgets can't see the woods for the trees. It was disappointing to hear that some of them didn't appear to be able to provide combination slow and fast acting NRT for example, which I understand is a successful strategy in SSS generally. And the logistical nightmare that some appeared to be having in actually getting NRT to patients (finding a prescriber etc) is regrettable.

I was also disappointed to hear someone describe ecig use as "maintaining smoking". That is not what it's about - it shouldn't be viewed simply as something people can do instead of smoking until the next time they can smoke (presumably when they leave the facility), but it is setting them on the course of switching to a safer alternative, perhaps permanently as May did with NRT products. It's so much more than just something that temporarily alleviates the problems created by the smoke free requirements. 

As to the practicalities of ecig use on wards and within facilities - that is unfamiliar territory for me. The impression I got was that on some wards anything which poses a potential danger to either the user (self harm or accident) or others who might get a hold of it and harm themselves or others is going to be an issue. There may be many situations for example, whereby refillable tank systems are not appropriate, but perhaps the disposable cigalike ones are. Or better, there is now quite a lot of what I think of as mid range products coming on the market, which have larger, rechargeable batteries and prefilled sealed cartridges in a small number of flavours. 

For any service to successfully introduce ecigs the staff are going to have a high degree of involvement and will need to understand the products, and that means limiting them to specified devices. I think your policy of limiting use to ones purchased only from the premises isa good one. That way you can ensure quality and safety, and it limits the amount of training staff will require, not to mention the issues of compatibility of chargers etc. I also took on board the issues of cigarettes (and by extension e-cigarettes) being used as currency, but that is always going to be a factor where there are limitations on supply (perhaps because of the cost). Presumably that would not be an issue once some gain medicinal licences and so can be prescribed. It's a shame that those ones will be the rather naff boring ones..

I couldn't end this without mentioning the two ladies from Kent SSS who spoke so enthusiastically about the service they provide - what an inspiration they were! The number crunchers who have suggested that SSS is not good value for money in some areas need to meet people like them and see if they still feel the same."

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