—by Paul M. Kubek and Matthew K. Weiland
Listen to Shelly Kiser tell her story of Allena.
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Columbus, OH—Sometimes it takes a personal tragedy to inspire the kind of advocacy that is necessary for significant, widespread change. This is one reason why Shelly Kiser is so passionate about efforts in Ohio to bring tobacco-recovery and cessation services to people with severe mental illness. Her sister-in-law, Allena, who lived with schizophrenia, died of cancer at age 43. She had smoked cigarettes most of her life.
"It was a horrible thing to watch," Kiser says. "She did not die from schizophrenia. She died from smoking."
As director of advocacy at the American Lung Association's regional office in Columbus, Kiser knows the statistics. People with severe mental illness die, on average, 25 years earlier than their non-mentally ill peers. Many of these deaths are caused by tobacco-related illnesses, such as cancer, heart disease, and emphysema and other lung diseases.
"She went to a mental-health center to get her medications. She saw those people all the time. If they had given her [smoking-cessation services] there with her regular counseling, she could be alive today."
— Shelly Kiser, family member & advocate
Kiser also knows that smoking-cessation programs have been effective for people in the general population. Smoking has decreased nationally to about 20 percent. Yet, these programs have not been effective for people with severe mental illness: more than 75 percent of people diagnosed with a severe mental illness or substance use disorder still consume tobacco products.
For Kiser, the tragedy of her sister-in-law's death has brought feeling to the tobacco statistics and meaning to the importance of reducing and eliminating tobacco use.
Kiser explains that, although Allena had been hospitalized several times when she was younger, she did experience success with mental-health recovery and, thus, an increasing quality of life. She achieved some symptom stability with medication management and other forms of treatment. As a result, she had not been hospitalized for a long time, was living in an apartment of her own, and had meaningful relationships with a boyfriend and family members.
Kiser emphasizes that Allena always wanted to quit smoking and made many attempts but could not break her dependence upon nicotine. When she was diagnosed with breast cancer at age 40, she tried again.
"I found out about a program that offered free nicotine replacement therapy," Kiser wrote in the Winter 2007 issue of NAMI Ohio Newsbriefs (click here). "But the program required that she attend a number of group counseling sessions to qualify and that was too intimidating for her."
ADVOCATING FOR FUNDING & SERVICES
Kiser has been an active member of the advisory committee of the State of Ohio initiative that has supported the development and dissemination of "Tobacco: Recovery Across the Continuum" (TRAC), a stage-based motivational service model for people with severe mental illness and/or substance use disorders. This initiative began in 2007 with funding from the Ohio Department of Mental Health, Ohio Department of Alcohol and Drug Addiction Services, Ohio Department of Health, and the now defunct Ohio Tobacco Prevention Foundation.
The TRAC model was developed by the Center for Evidence-Based Practices (CEBP) at Case Western Reserve University. Kiser has been a tireless advocate to preserve funding for TRAC and to preserve and restore funding for many other tobacco-prevention programs throughout the State of Ohio.
TOBACCO RECOVERY FOR SEVERE MENTAL ILLNESS
Traditionally, behavioral healthcare providers have viewed tobacco treatment as the responsibility of primary healthcare. TRAC changes this. It integrates tobacco treatment with existing behavioral healthcare approaches. In other words, consumers do not have to travel to another agency to start the process of cutting back and quitting. They can do it at the mental-health center or addiction-service agency. The TRAC model helps consumers in all stages of readiness to change their tobacco use, not just those in the action stage who are ready to quit.
Kiser is convinced that her sister-in-law would have benefited from this approach.
"She went to a mental-health center to get her medications," Kiser says. "She saw those people all the time. If they had given her [smoking-cessation services] there with her regular counseling, she could be alive today. So that's why I feel so passionate about this."
Paul M. Kubek, MA, is director of communications at the Center for Evidence-Based Practices at Case Western Reserve University. Matthew K. Weiland, MA, is a producer and editor based in Cleveland, Ohio.