QuitPick: Best practice smoking cessation care for individuals receiving mental health services

QuitPick intervention: - Quit pack of written resources from Quitline Victoria will be mailed to participants. Extended and tailored Quitline counselling with a dedicated counsellor: Proactive referral (opt-out; where Quitline contacts the participant) made by the research team (with consent via REDCap) to tailored counselling for people with SMI. Following the Quitpick treatment protocol (i.e., different from standard Quitline practice) including offer of weekly calls within the 12-week period; structured monitoring of mental health symptoms, nicotine withdrawal symptoms and medication side effects (the latter may increase due to medication interactions with smoking cessation); and the use of mood management strategies that dually act to aid mood and cessation (e.g., exercise, scheduling pleasant activities). A dedicated counsellor will manage counselling for each participant. Counsellors will monitor and encourage correct use of nicotine replacement therapy and nicotine vaping products and will address barriers to use. Quitline has established protocols to support people using nicotine vaping products for smoking cessation and also offers support to people wanting to reduce or cease vaping, with a focus on preventing smoking relapse or increases in smoking. - Peer support forum: Access to study website with peer worker videos sharing lived experienced of mental health conditions / smoking and recovery (including recommendation and encouragement with engage with Quitline) and online forum where participants can ask questions, share experiences and support each other. This messaging style forum will be monitored by peer workers (supervised by the chief investigator) and enhance engagement with the intervention by providing lived experienced expertise, encouragement, and resources to tackle smoking and other areas of physical health. The online forum will be hosted on Facebook. Participants will be offered the opportunity to join the study’s Facebook support group page. The group will be set up using the ‘secret’ group setting from Facebook; a secret group that involves only those an administrator allows to participate. Participants are not required to post to the Facebook group page. Upon enrolment, we will advise participants that if we become concerned about any one individual’s need for additional counselling, we will refer him or her to appropriate services. We have successfully used this method in previous studies (ACTRN12621001315808). Approximately bi-weekly (depending on participant recruitment rate) material on tackling smoking, stories of lived experience and encouragement for quitting will be posted on the Facebook group. Peer workers will monitor postings weekly and respond when appropriate (clarifying, answering questions, offering encouragement, or asking additional facilitating questions). Use and acceptability of the forum will be assessed using self-report items within the follow up assessments. - Pharmacotherapy (12 weeks choice of state-of-the-art nicotine vaping products or combined nicotine replacement therapy and GP support: o Week 1 trial pack: The study GP will review participants’ baseline assessments for relevant information (e.g., nicotine dependence, current medications likely to be affected by smoking cessation and take action/make appropriate referrals). An initial assessment via telehealth will be conducted with the trial GP to address health and safety issues and any concerns and to help the participant for when they make an informed choice to proceed with either nicotine vaping products or combination nicotine replacement therapy for the remainder of the intervention period. An e-script will be sent to our partnering Australian pharmacy and a 1-week supply of nicotine vaping products and combination nicotine replacement therapy (patches plus lozenges as per best practice) with written resource guides for use will be sent to the participant to trial, matched to nicotine dependence. Allo vapes are a quality, nicotine delivery system that has been selected for their simplicity and ease of use. Participants’ nominated GP will be advised what treatments have been prescribed. o Week 2: Participants will be sent their choice of either a remaining 11 week supply of nicotine replacement therapy or nicotine vaping products. Use of nicotine replacement therapy and nicotine vaping products will be assessed within follow up assessments using participant self-report items. The study links together three existing supports already available to participants in the community/through their mental health service – Quitline counselling, peer workers and nicotine replacement therapy. Following the 12-week intervention period, participants can continue to access these resources. - Engagement with GP and mental health providers: Participants will be asked to provide the details of their current GP and/or psychiatrist. A letter will be sent by the research team to these health professionals with information about their client’s trial participation and a link to Australia’s smoking cessation guidelines for health professionals (includes a list of medications affected by smoking) and peer-reviewed articles that provide practical advice to assist doctors in helping people with SMI to quit smoking. Participants will receive a Quitting Mood and Experiences diary which they will be encouraged to use and discuss with the study GP, Quitline counsellor and other health professionals as relevant. Quitline will provide written feedback to treatment providers at the end of the telephone counselling program. They 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. - Quitline engagement of support network: A Quitline brochure for carers which offers Quitline as a resource for supporters of people with SMI to address any queries/concerns about quitting.