was created to address the serious healthcare problem of smoking among individuals with mental illness. Seventy percent of mental health consumers are current smokers, rates that are 2-4 times greater than the general population. In addition, smokers with mental illness have an increased risk for tobacco-caused illnesses and reduced access to tobacco treatments. Despite these figures, many mental health treatment facilities still do not offer any services to help consumers quit smoking.
Dr. Jill Williams, Director of Mental Health Tobacco Treatment Services, at the Rutgers Robert Wood Johnson Medical School-Division of Addiction Psychiatry (Rutgers-RWJMS), was frustrated by the lack of progress to educate mental health consumers about the importance of addressing smoking. She believed that given the correct information and choices, consumers will take steps to lead healthier lives. Research has shown that people listen to their peers and look to them for support. When mental health consumers reach out to one another it can lead to change in terms of individual behavior and the mental health system’s response to a problem. Dr. Williams saw this peer-to-peer approach as an opportunity to increase consumer awareness of the negative consequences of smoking and the fact that effective treatment exists. This in turn would empower them to make educated decisions regarding how they live their lives and provide a platform from which consumers could advocate for greater access to treatment resources.
To reach consumers, Dr. Williams sought the help of the Mental Health Association in New Jersey (MHANJ) and Marie Verna, the organization's Director of Advocacy who is herself a person with a mental illness. Ms. Verna concurred with the theory that the best way to bring about significant systems change is to listen to consumers' needs and implement services according to what consumers say works - not necessarily what professionals say or what family members say. Through the MHANJ and their Consumer Advocacy Partnership, Dr. Williams was led directly to consumers who were interested in hearing more about the possibility of quitting smoking - forever. Once the consumer voice began to speak, MHANJ was able to bring the issue to the attention of administrators in the Department of Human Services and the Division of Mental Health Services, the policymakers who most directly affect funding for the overall health of people with mental illness.
In 2005, thanks to a grant from the American Legacy Foundation, UMDNJ-Robert Wood Johnson Medical School-Division of Addiction Psychiatry, the Mental Health Association in New Jersey (MHANJ) and the State of New Jersey Mental Health Services (DMHS) joined as partners to begin CHOICES, an innovative peer-to-peer support network of mental health consumers that encourages fellow consumers to make a positive lifestyle change by addressing their tobacco use.
Martha Dwyer, MA, LCADC, CTTS served as Program Director for the CHOICES team from 2005 until her retirement in 2010. Martha has an extensive background as an Addictions Professional in NJ and is also a Certified Tobacco Treatment Specialist and former Consultant to Addictions Programs at the UMDNJ-Tobacco Dependence Program.
Patricia Dooley, MA, LPC, CTTS joined the CHOICES team in 2010 as Program Director. Trish has a Master’s Degree in Counselor Education, and is a Licensed Professional Counselor, as well as a Tobacco Treatment Specialist. Trish has been the clinician for a number of clinical trials specific to various medications and behavioral therapies for tobacco dependence in the SMI population in the Division of Addiction Psychiatry. In her new role, Trish will manage many of the day to day operations and help to organize the CHOICES team. She serves as a supervisor to the Consumer Tobacco Advocates.
KICK OFF EVENT
The official kick-off for CHOICES was celebrated in Trenton, New Jersey on June 15th, 2005. Consumers, mental health professionals and government officials attended.
In her opening remarks, Dr. Jill Williams, the Medical Director of CHOICES, explained that CHOICES is a peer-to-peer support network of Consumer Tobacco Advocates. These mental health consumers try to reach out to other consumers who smoke. The audience heard from representatives of he three partnering organizations and from mental health consumers who themselves are trying to quit smoking.
Department of Human Services Commissioner James Davy said, “Excessive smoking can be a major problem among people with mental illness. This [CHOICES] is an innovative way to address this and have a positive impact on the lives of people with mental illness.” He also expressed special appreciation for the vision and work of Dr. Williams.
Carolyn Beauchamp, President and CEO of the Mental Health Association in NJ, noted “smokers with psychiatric disorders consume nearly half of all cigarettes in the United States. Only recently have public health specialists and clinical researchers begun to better understand and treat this major problem.” The audience enthusiastically applauded when three mental health consumers shared their own experiences with quitting.
A Rutgers UBHC mental health counselor talked about the positive response he has received from consumers when he helps them address smoking as part of their recovery. CHOICES has met with similar enthusiasm and support as word of the program spreads throughout the mental health community.
In July 2005, two mental health consumers were hired as Consumer Tobacco Advocates and received training to prepare them with the skills and knowledge to reach out to their peers that smoke. The Consumer Tobacco Advocates (CTAs) are paid peer counselors who work on a 20-hour/ week stipend on focused tobacco activities including implementing a one-session motivational intervention with other mental health consumers. In August 2005, they began visiting self-help centers, mental health programs and health fairs. They have also participated in conferences in New Jersey attended by mental health consumers and staff. As of November 2006, the Consumer Tobacco Advocates have carried their message to over 2400 consumers that smoking is harmful and that treatment works. They have also met with 370 consumers individually to provide personal feedback regarding the health and financial consequences of their smoking.
In our second year the NJ State Division of Mental Health Services and the Cancer Institute of NJ joined the American Legacy Foundation in funding CHOICES. The addition of two new CTAs has allowed expansion of outreach efforts to Consumer Connections, NAMI in New Jersey, Self-Help Centers and supportive housing. CHOICES is now a mainstay at all of the major consumer conferences and advocates events that occur in New Jersey. These events offer access to different populations of mental health consumers than those seen at treatment sites and provide important opportunities for networking.
The visibility of CHOICES expanded to a national audience when CHOICES was presented in poster form at the World Conference on Tobacco or Health in Washington, DC, July 2006 and when MHANJ gathered national support from associations at the National Mental Health Association's 2006 Fall Policy Conference in Baltimore, MD. We have been contacted by individuals outside of New Jersey expressing interest in establishing a CHOICES program in their states.
CHOICES received national recognition by the American Psychiatric Association (APA), which granted a Silver Achievement Award to the CHOICES program ib October 9, 2009 in New York City.
CHOICES also received a grant from the American Medical Association’s Foundation Fund for Better Health in 2009. The Fund for Better Health awards grants for grassroots public health projects that target the issue of healthy lifestyles in communities across the United States. This year’s focus was on programs that address: nutrition and physical fitness; alcohol, drug and smoking; and violence prevention. Due to rising printing and postage costs, this grant award will allow the CHOICES program to continue to mail our newsletters to our readers who do not have access to email.
Our Advocates have grown professionally and personally in their employment with CHOICES. They are applying for scholarships to become consumer leaders. One CTA has become an active member of Advocacy Council of MHANJ Government Affairs Department. The CTAs share that the experience of working for CHOICES has been helping their self-esteem and personal recovery from mental illness. They are being recognized for their importance as peer leaders and role models for the mental health community from consumers and professionals.
We launched our first issue of the CHOICES newsletter in June 2005. Our sixth and most recent issue was published November 2006. Consumers are encouraged to sign-up to receive the newsletter by mail or e-mail and to submit contributions. Consumers write personal testimonies about the processes of smoking and quitting and have also submitted poems and other artwork for the newsletter. We welcome all contributions. The newsletter can also be found online here.
Our website was established in November 2005. This website was created as an additional tool to link consumers with mental illness who smoke to available resources and provide a place for consumers to share their ideas. Our website includes information about the CHOICES program, copies of our newsletter and links to other mental health and tobacco treatment resources. The response from mental health consumers has been enthusiastic.