Quality statement 7: Promoting healthy eating, physical activity and smoking cessation

Quality statement

Adults with psychosis or schizophrenia are offered combined healthy eating and physical activity programmes, and help to stop smoking.

Rationale

Rates of obesity and type 2 diabetes in adults with psychosis or schizophrenia are higher than those for the general population. Rates of tobacco smoking are also high in people with psychosis or schizophrenia. These factors contribute to premature mortality. Offering combined healthy eating and physical activity programmes and help to stop smoking can reduce these rates and improve physical and mental health.

Quality measures

Structure

a) Evidence of local arrangements to ensure that adults with psychosis or schizophrenia are offered combined healthy eating and physical activity programmes.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that adults with psychosis or schizophrenia who smoke are offered help to stop smoking.

Data source: Local data collection.

Process

a) Proportion of adults with psychosis or schizophrenia who received combined healthy eating and physical activity programmes within the past 12 months.

Numerator – the number in the denominator who received combined healthy eating and physical activity programmes within the past 12 months.

Denominator – the number of adults with psychosis or schizophrenia.

Data source: Local data collection. Data can be collected using the Royal College of Psychiatrists' National audit of schizophrenia Audit of practice tool, question 40.

b) Proportion of adults with psychosis or schizophrenia who smoke who received help to stop smoking within the past 12 months.

Numerator – the number in the denominator who received help to stop smoking within the past 12 months.

Denominator – the number of adults with psychosis or schizophrenia who smoke.

Data source: Local data collection. Data can be collected using the Royal College of Psychiatrists' National audit of schizophrenia Audit of practice tool, question 40.

Outcome

a) Type 2 diabetes rates in adults with psychosis or schizophrenia.

Data source: Local data collection.

b) Obesity rates in adults with psychosis or schizophrenia.

Data source: Local data collection.

c) Smoking rates in adults with psychosis or schizophrenia.

Data source: Local data collection. Data can be collected using the Royal College of Psychiatrists' National audit of schizophrenia Audit of practice tool, question 31.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers (mental health services) ensure that systems are in place for adults with psychosis or schizophrenia to be offered combined healthy eating and physical activity programmes, and help to stop smoking.

Health and social care practitioners ensure that they are aware of local healthy eating and physical activity programmes and offer these to adults with psychosis or schizophrenia. They should also offer them help to stop smoking if they smoke.

Commissioners (such as NHS England local area team and local authorities) ensure that they commission services that make sure adults with psychosis or schizophrenia are offered combined healthy eating and physical activity programmes, and help to stop smoking.

What the quality statement means for patients, service users and carers

Adults with psychosis or schizophrenia are offered help with healthy eating and physical activity to help prevent weight gain, diabetes and other health problems that are common in adults with psychosis or schizophrenia and often related to treatment. Smoking is also common in adults with psychosis or schizophrenia and those who smoke should be offered help to stop smoking.

Source guidance

Definitions of terms used in this quality statement

Help to stop smoking

Health and social care practitioners should consider one of the following to help people with psychosis or schizophrenia stop smoking, even if previous attempts have been unsuccessful:

  • nicotine replacement therapy (usually a combination of transdermal patches with a short‑acting product such as an inhalator, gum, lozenges or spray) for people with psychosis or schizophrenia or

  • bupropion[3] for people with a diagnosis of schizophrenia or

  • varenicline for people with psychosis or schizophrenia.

They should warn people taking bupropion or varenicline that there is an increased risk of adverse neuropsychiatric symptoms and monitor them regularly, particularly in the first 2–3 weeks.

Health and social care practitioners should be aware of the potential significant impact of reducing cigarette smoking on the metabolism of other drugs, particularly clozapine and olanzapine. [Psychosis and schizophrenia in adults (NICE guideline CG178)]

Equality and diversity considerations

When referring people to services, health and social care practitioners should take into account the 'negative' symptoms of psychosis and schizophrenia (such as emotional apathy, lack of drive, poverty of speech, social withdrawal and self‑neglect), and ensure services are accessible for people with these symptoms.

Health and social care practitioners should be aware of the impact of social factors, such as inadequate housing, lack of access to affordable physical activity, poor cooking skills and limited budget for food, on continued healthy eating and physical activity.



[3] At the time of publication of Psychosis and schizophrenia in adults NICE guideline CG178 (2014), bupropion was contraindicated in people with bipolar disorder. Therefore, it is not recommended for people with psychosis unless they have a diagnosis of schizophrenia.