Quitlink: Peer worker facilitated Quitline support for smokers receiving mental health services

Intervention (Quitlink) Intervention participants will receive standard smoking care as in the control condition plus additional support. As in the control condition, the standard care is delivered by a peer worker (either verbally by the peer worker for face-to-face or telephone assessments; or via a video for online participants). and includes advice to quit, encouragement to use NRT, and a Quit Victoria pack of written materials to motivate a quit attempt (e.g. costs of smoking and benefits of quitting) and resources to support self-management (e.g. Quitline phone number, ‘4Ds’ strategy: Delay, Deep-breathe, Drink water, Do something else’ to manage cravings; using NRT products). With consent, a letter will be sent by the research team to nominated health professionals (GP/psychiatrist) with information about their client’s trial participation and a link to Australia’s smoking cessation guidelines for health professionals, which includes a list of medications affected by smoking. Additionally, the intervention group will receive: • Referral to Quitline: immediately following the brief intervention, the peer worker will make a proactive referral to Quitline. For participants recruited online, the Quitline referral will be made automatically by RedCap. • Manual guided Quitline counselling: Quitline will then call the participant to offer the Quitlink service. This service includes up to seven scheduled calls with additional calls allowed to deal with relapse crises within an eight-week period. Calls are scheduled approximately weekly or according to caller preference for pre-quit calls and post-quitting calls follow a relapse-sensitive schedule. It includes structured monitoring of mental health symptoms, nicotine withdrawal symptoms and medication side-effects; and a focus on psychoeducation including the relationship between smoking and mood; goal setting; identification of triggers to smoke; and facilitating problem solving and skills building, including the use of mood management strategies that also act to aid cessation (e.g., exercise, scheduling pleasant activities). A dedicated Quitline counsellor will manage the quitting process for each participant. • As in the control condition, with consent, a letter will be sent to the person’s general practitioner and/or psychiatrist. Additionally for the intervention condition, peer reviewed articles that provide practical advice to assist doctors in helping people with mental illness to quit smoking will be included (Mendelsohn and Montebello, 2013; Mendelsohn et al., 2015). Additionally, participants will receive a Quit Victoria brochure for carers and a Quit Victoria stop smoking moods and experiences diary. • Quitline engagement with mental health services: Quitline will provide written feedback to treatment providers at the end of the telephone counselling program. Providers will be encouraged to monitor and support cessation efforts whenever appropriate. In addition, Quitline will contact the mental health treatment provider, if concerns arise about mental health issues. • NRT: Participants will initially be provided with a four week supply (enough for daily use) of patches plus their choice of oral-form NRT (gum, lozenge, inhalator, spray). These products include: * Patch (Transdermal; 21mg) * Gum (Oromucosal; 2 mg) * Lozenge (Oromucosal; 2 mg) *Inhalator (Oromucosal; 15mg per cartridge) * Spray (Oromucosal; 1mg 150 sprays) The research team will post NRT to participants with an information pack that includes printed instructions on how to use NRT correctly, for how long, potential side effects (and when to notify a health care provider), and safe storage and handling. Quitline counsellors will monitor and encourage correct use of NRT and address barriers to use. Intervention participants that decide to use the supplied NRT will receive a final 4-week supply of NRT as per the initial supply. Quitline counsellors will ask participant preferences for oral dose forms during the Week 2 call (for those participants that do not engage with Quitline, the peer worker will contact participants to determine participant preferences for NRT) in order for NRT to be delivered to the participant by Week 4. Participants who desire to shift to use of a prescription-based stop smoking medication (e.g., varenicline) will be supported to do so, but the study will not fund the purchase (which is low for those with health care cards as it is heavily government subsidized). The Quitlink intervention is similar to the Quitline’s routine care for clients disclosing mental health issues. Components unique to this trial include the peer worker referring to Quitline, a dedicated counsellor for each participant and provision of NRT.