Tobacco dependency treatment services for people with severe mental illness: A mixed methods rapid evaluation [version 1; peer review: 1 approved with reservations]

Background
Smoking rates are higher among people with severe mental illness (SMI), contributing to significant health disparities and a reduced life expectancy compared to the general population. Amid these inequalities, NHS England piloted tobacco dependency services for people with SMI across seven sites in England. We conducted a rapid evaluation to better understand:

1. How tobacco dependency treatment services for people with SMI are delivered.
2. How success of the services is defined and measured.
3. What referral pathways are in place and how these have changed over time.
4. What the costs of delivering the services are.

Methods
Initial scoping work to determine study feasibility and to inform the methodological design of a rapid evaluation. The full evaluation utilised the following: interviews with service staff (n=11), a survey of service staff (n=42), workshops with people with lived experience of smoking and SMI (n=15), and a workshop with NHS England and case study site leads.

Results
The way in which services are delivered is largely tailored to individual needs. Staff and people with lived experience both viewed broader metrics, like physical health and user experience, as more important than 28-day smoking quit rate that is commonly collected by generic tobacco dependency services. Efforts to expand the pathways via which people are referred into the services requires significant resources and faces many barriers, such as misconceptions about the motivations of people with SMI to quit. Comprehensive cost information was difficult to access amongst sites, making it difficult to understand the true cost of providing the services.

Conclusions
The research highlights the importance of a tailored service for people with SMI, but that additional metrics could be more broadly captured on service user outcomes and service costs. There are also significant referral pathway barriers which could be addressed.