A sign denotes the campus of NorthCare in Oklahoma City as tobacco-free. (Provided)

Much has changed since the 1970s, when Nancy Reed started working with Oklahomans in search of mental health services.

In those days, it seemed cigarettes and mental health treatment went hand-in-hand. Smoke breaks were frequent, and cigarettes were offered to nearly all who were seeking mental health treatment.

“You were an outcast if you didn’t smoke,” said Reed, who started smoking while working at an in-patient treatment facility. She quit smoking seven years ago.

Reed, the performance-improvement coordinator, safety coordinator and wellness champion at NorthCare in Oklahoma City, looks out over a campus that is tobacco-free. She encourages staff and consumers — Oklahomans seeking services —  to take in-house cessation classes, call the Oklahoma Tobacco Helpline and adopt a healthier lifestyle.

This movement toward tobacco-free facilities and a healthier workforce and patients is thanks in part to a partnership between TSET and the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS).

ODMHSAS commissioner: Almost half of all mental health patients smoke

TSET and ODMHSAS have partnered since 2009 to make changes within the state’s mental health system that promote tobacco-free substance abuse treatment programs and incorporate overall health and wellness into all aspects of mental health services.

TSET is a voter-created agency that uses the earnings from an endowment to fund grants and programs to prevent and reduce tobacco use in Oklahoma. The TSET endowment is fueled by a portion of annual payments to the state from tobacco companies as part of the 1998 Master Settlement Agreement.

One of the major accomplishments of the partnership between TSET and ODMHSAS is a policy that requires agencies providing mental health services, whether contracted or certified by ODMHSAS, to be tobacco-free and incorporate tobacco cessation into their overall work.

“The reality is that 44 percent of all cigarettes being smoked, nearly half, are being smoked by people who have either a mental illness or substance abuse issue,” said ODMHSAS commissioner Terri White. “This is a priority concern for behavioral health providers, as the tobacco use complicates the client’s overall health and hampers long-term recovery efforts.”

There is a growing body of evidence that shows people with a substance-abuse disorder are more successful at avoiding a relapse if they quit tobacco while seeking treatment for an addiction. Research also shows that people in recovery from depression or mood disorders experience fewer symptoms if they have quit tobacco as part of their treatment.

“And, let’s remember that many of the people entering treatment want to quit,” said White. “They want to be healthy and they want to have quality of life. Why would we treat the brain and ignore the risk of additional disease caused by tobacco use?”

State’s mental health facilities all on board and tobacco-free

Oklahoma is one of a handful of states that has instituted smoking-cessation interventions and tobacco-free policies at all of its mental health treatment facilities, in addition to creating and implementing behavioral-health homes for consumers. TSET and ODMHSAS have also partnered to increase referrals to the Oklahoma Tobacco Helpline. There have been more than 23,000 ODMHSAS referrals to the Helpline over the past five years.

“TSET’s partnership to support a tobacco-free system within our state’s mental health system is another way we are working to incorporate proven and promising practices to prevent and reduce tobacco use for all Oklahomans,” said TSET executive director John Woods. “We’ve seen how tobacco-free policies at schools and city property have helped promote healthy environments, and consumers within the mental health system should have access to those same promising practices that promote healthy lifestyles.”

People diagnosed with a serious mental illness face an increased risk of having chronic medical conditions. On average, adults living in the United States with a serious mental illness die an average of 25 years earlier than others — often from preventable and treatable medical conditions, according to the National Alliance on Mental Illness.

Reed: Quitting smoking improves patients’ chances of living better

On a recent sunny morning at Oklahoma City’s NorthCare facility, people trickled out of the building where they can receive integrated services for mental and physical health. Reed and her colleagues, many who have also quit smoking over the years, frequently remind people that the campus is tobacco-free. The facility staff hand out small cards that advertise a weekly, on-site tobacco-cessation class and also 1-800-QUIT-NOW, the Oklahoma Tobacco Helpline.

As Reed reminds visitors of the tobacco-free policy, she’s also taking time to answer questions and share her story.

“I used to smoke, too, but I’ve been a non-smoker for seven years now,” Reed tells a visitor, who asked where she could smoke. “I really wish you’d quit. We’ve got classes here to help you quit. I bet you’ve done harder things.”

As these conversations progress, most express a desire to quit smoking, but doubt their ability to do it. Reed and other staff remind them they can get coaching and nicotine replacement patches, gum or lozenges — and that they are not alone.

“I think of the consumers I’ve lost over the years who were really in recovery, living independently, and suddenly they drop dead of a heart attack because they’ve been a lifelong smoker,” Reed said. “And for many years, we were part of a system that encouraged a practice that can eventually kill our consumers. They have a better chance of living the lives they want to live if they’ve quit smoking.”