Barriers to implementing evidence-based smoking cessation practices in nine community mental health sites

Objective: Guidelines strongly recommend that smokers with mental illness receive evidence-based smoking cessation interventions similar to those provided to smokers in the general population. The goal of this study was to evaluate the resources, barriers, and willingness to use these evidence-based interventions in mental health settings. Methods: Clinicians at nine community mental health settings (five psychosocial rehabilitation programs and four community mental health clinics) in four counties in Maryland were surveyed. The questionnaire-the Evidence- Based Practice Attitude Scale-15-evaluated availability, barriers, and utilization of smoking cessation assessment and treatment, including willingness to use evidence-based practices. Results: Ninety-five clinicians participated in the study. Most were full-time employees (84%) with master's degrees (56%). The vast majority were nonsmokers or former smokers (94%). Less than half (42%) of the clinicians reported asking their patients about smoking. Less than a third (33%) advised or assisted in smoking cessation. Very few (10%) reported referring identified smokers to telephone quitlines. About a quarter (26%) reported being confident about their ability to provide smoking cessation counseling. A major barrier to providing cessation counseling was the belief that patients were not interested in quitting (77%). On average, clinicians reported a great willingness to use evidence-based smoking cessation interventions if they received appropriate training. Conclusions: Mental health clinicians working in community mental health settings were not consistently providing evidence-based smoking cessation interventions. Barriers appear to be modifiable through training and education.