Recognizing the Need
Across the nation, tobacco-free policies are making workplaces, school campuses and homes safer. Meanwhile, there have been relatively few policies aimed at community mental health boards.
In Michigan, community mental health boards serve clients of all ages and backgrounds - children with intellectual developmental disabilities, adults with severe emotional disturbances and mental illnesses and elderly clients with mental illnesses. They provide services including treatment, counseling, health care and job training.
These facilities face some of the greatest tobacco use disparities. Individuals with a psychiatric or substance abuse disorder smoke 44 percent of all cigarettes consumed in the United States.1
Jim Harrington, Field Organizer for the American Lung Association of Michigan, knew it was time for a change. Harrington approached Northern Lakes Community Mental Health to partner on the creation of a tobacco free campus policy. Greg Paffhouse, CEO of Northern Lakes Community Mental Health, recognized the burdens tobacco use placed on his agency's clients - not just their health but also their pocketbooks.
With buy-in from Northern Lakes and a grant from the American Lung Association National Office, work began to create the systems change needed for a supportive, tobacco-free environment.
Changing the System
Harrington says that creating a tobacco-free environment at a public mental health board involves more than hanging up "no smoking signs." A strong policy was enacted that prohibited the use of all tobacco at all Northern Lakes facilities. Northern Lakes also changed their health records system to track tobacco use status.
Staff were trained to talk with every client about tobacco use and to have conversations about quitting with clients. Northern Lakes also made sure culturally appropriate cessation services were available to staff and clients.
Harrington notes the importance of this comprehensive approach to tobacco work.
Paffhouse says this project is particularly important in mental health as it represents a system change to the way his field has treated tobacco. He blames stigmas held by some for the lackluster cessation efforts of the past.
Champions for Change
Harrington and Paffhouse credit the staff at Northern Lakes Community Mental Health with much of the success of the environmental and policy changes.
Because the organization is made of up a variety of providers across six counties, Paffhouse believes a top-down directive would have failed. Instead, staff members at each of the four office locations acted as change champions. Several of the champions were either ex-smokers or were quitting themselves. Multiple staff members told Paffhouse that the new changes provided the motivation they needed to quit.
The staff also played a crucial part in the roll out of the tobacco-free campus since they were the people having one-on-one conversations about the new policy with other staff and clients. They reported back on which changes other staff and clients were excited about and which ones generated concerns.
The tobacco-free work at Northern Lakes Community Mental Health also received support from other service organizations in the community.
Jim Moore, the Executive Director of the Disability Network / Northern Michigan, sat on the leadership team that crafted the Northern Lakes policy. As many of the Disability Network's clients overlap with Northern Lakes' clients, Moore knew that the policy would be more successful if clients heard similar messages from both organizations.
Moore believes the combined expertise of tobacco control, mental health and community services organizations will create stronger prevention and cessation efforts and reach more people than their organizations have reached individually.
As successful implementation continues at Northern Lakes Community Mental Health, Harrington hopes that this policy will serve as a model for other mental health boards across Michigan and nationwide.
Meanwhile, Paffhouse remains focused on making sure this particular policy remains successful.
Lasser K, Wesley BJ, Woolhandler S, Himmestein DU, McCormick D, Bor DH. Smoking and mental illness: A population-based prevalence study. JAMA. 2000; 284:2606-2610.
Page last updated: March 3, 2020