Perspectives on smoking cessation for people with severe and enduring mental health and substance misuse: a qualitative investigation

Context: Smoking is the largest avoidable cause of death in the UK. Although smoking rates are decreasing among the general population, people with mental health difficulties and substance misuse continue to smoke at a considerably higher rate. Aim: The aim of this thesis portfolio is to contribute to a greater understanding of the perspectives of people with mental health difficulties and substance addictions about smoking and smoking cessation. It also aims to provide insight into how healthcare providers can better support this vulnerable group of people to stop smoking. Design: This thesis is presented in a portfolio format. It includes: a brief introduction, systematic review, bridging chapter, empirical paper, extended methodology chapter and an overall discussion and critical evaluation. The systematic review synthesises qualitative literature investigating the views of staff and service users about smoke-free mental health inpatient units. The empirical paper uses a grounded theory approach to explore the process of smoking cessation for people with dual-diagnosis. Findings: The systematic review identified five themes relating to the barriers and facilitators to the implementation of smoke-free policies: ward culture, resources, attitudes, smoking cessation and policy strategy. The findings from the empirical paper suggest that intrapersonal factors, such as motivation and ability, play a significant role in the process of smoking cessation. The results emphasise the layers of interpersonal, social and system factors that influence individual behaviour change. Conclusions: Findings of this portfolio are presented tentatively, as further research is required. However, the results have clinical implications for healthcare providers and for the development of appropriate smoking cessation interventions for people with mental health and addictions