Although smoking rates among the general population continue to fall, they have remained disproportionately high among people with lived experience of mental health challenges. The move towards recovery focused mental health services in Ireland has further highlighted the need to find a way to address nicotine dependence and improve the quality of care in all our mental health services to ensure no one gets left behind. Over the past year, Mental Health Ireland, the HSE Tobacco Free Ireland Programme and people with lived experience of mental health challenges have been working together to identify innovative ways to tackle this growing health inequality. The consensus is that this requires a social movement across the whole system. This will hardwire the voice and experience of people with mental health challenges and their supporters into a common endeavour; to assist people attending mental health services in living a smoke free life. 

We adopted a co-production approach as a way to address this. In July 2019, we hosted the first National Conversation Café: Smoking, Mental Health and Recovery in order to have an open, honest and direct conversation where all perspectives on this issue were articulated and recorded. More than 70 stakeholders from lived experience of mental health challenges, services providers, supporters, smokers and ex-smokers came together on an equal footing, in the spirit of co-production, to tell the story of how things are now in terms of smoking and mental health and to contribute to a solution-focused plan for the future. 

The cumulative feedback from the Conversation Café represents a strong mandate for a whole organisation co-produced approach with a clear focus on the provision of the right support, at the right time, in the right place. People with lived experience of mental health challenges do not lack motivation to quit but are more likely to be highly addicted and heavily dependent on tobacco. Therefore, they need consistent, intensive cessation support and a supportive environment along the continuum of care. The feedback indicated a strong desire to see an attitudinal shift in mental health services to address unhelpful ingrained beliefs and defeatist assumptions that addiction to nicotine among people with lived experience of mental health challenges is inevitable or intractable as it is not! 

There is no quick fix but in creating the opportunity for conversation we have started the journey. With a collective effort from all stakeholders, we will develop a roadmap that will incorporate the latest evidence, International best practice processes together with the voice of lived experience to co-produce a mental health service that will support people who want to quit smoking/live a smoke free life.