All going well, as far as we know…

Jim O’Rorke asks how we can know what is happening with service users after they’ve had discussions on smoking and mental health…

ASH Scotland staff have been delivering IMPACT Guidance training for over a year now. We’ve trained around 200 workers, volunteers and NHS staff about smoking and mental health. We’ve developed and delivered IMPACT Training for Trainers and a Continuing Professional Development Award for Smoking Cessation Workers; we’ve travelled from Edinburgh to Greenock to Orkney and many points in between.

We’ve just completed a survey of people we have engaged with to get their feedback about the quality and usefulness of IMPACT training and resources and its relevance to their work in supporting people with lived experience of mental health problems. I’m delighted (and relieved!) to say that the feedback was very positive. The material and resources we provide (free of charge) are, people responded, of a high quality and useful in their work. All respondents reported that they now regularly have conversations about smoking and mental health with the people they support. They also refer to the Guidance document (you can print out a copy here,) and use material from the Resources page from www.impact.scot regularly. The IMPACT training, which is also free as it is funded by the Scottish Government, scores very highly at around 9 out of 10 for all the training sessions we have provided.

So, we can feel rightly proud that IMPACT has had just that, an impact. The Scottish Government have also recognised the return on their investment in this public health initiative by citing IMPACT in the 2018 Tobacco Control Action Plan and in the First Progress Report of the 10-year Mental Health Plan.

So where is the “but” you ask? Our evaluation showed that whilst conversations about smoking and mental health were happening, information being provided, signposting to smoking cessation support being given, when asked how many Service Users had accessed support to quit, the overwhelming response was “Don’t Know”. Similarly when asked how many Service Users had actually quit smoking, overwhelmingly it was, “Don’t Know”.

This points to an issue beyond the scope of IMPACT. I’ve worked in many Third Sector services supporting people with lived experience of mental health problems. These services were often funded by the Local Authority, and each authority wanted to know what they were getting for the public money they were investing. Not surprisingly they often wanted to know the “hard” outcomes; the tangible, easily evidenced outcomes. So, when I worked in employability and supported employment services the outcomes demanded would be: number of jobs, number into vocational training, number into volunteering etc. In over three decades working in the sector we were never asked, “How many accessed smoking cessation support?”, or, “How many quit smoking?” With budgets being ever-squeezed, of course you will focus on the outcomes desired by funders, and stopping smoking ain’t one of them.

So the response to our survey is not surprising. Hard pressed workers will focus on the actual outcomes desired of their service. Failure to meet these can result in loss of contract or funding being withheld.

In IMPACT training we highlight the fact that a Service User stopping smoking can help a service achieve the outcomes demanded of them. For example, in an employability service, where getting a job is a major outcome; if a Service User manages to quit smoking they will experience:

· Better physical health (see this FREE poster from the IMPACT website).

· Better Mental Health (see the FREE IMPACT guidance).

· Better financial health (see the Cost of Smoking from ASH Scotland).

· Increased confidence and self-esteem from a successful quit attempt.

All these factors combined will enable the Service User to engage with support more effectively and increase the likelihood of getting a job. So although stopping smoking is unlikely to be an outcome for your service, you can see how this will support your service to achieve the outcomes that are demanded.