Mental Health Provider Attitudes Towards Tobacco Treatment for Veterans with Serious Mental Illness: A Qualitative Analysis

Veterans with serious mental illness (SMI) smoke at disproportionally high rates but receive evidence-based tobacco treatment at disproportionally low rates. Mental health providers have frequent contact and strong relationships with veterans with SMI, making them well-suited to deliver tobacco treatment. Historically, mental health providers have been hesitant to address tobacco use. This project involved one-on-one interviews with 20 providers (7 prescribers plus 13 non-prescribers) from outpatient SMI clinics in a Mid-Atlantic Veterans Affairs Medical Center to understand current tobacco treatment practices and inform efforts to improve mental health provider delivery of this treatment. Interview guides and domains were informed by the Theory of Planned Behavior, which posits that attitudes, perceived control and self-efficacy, and social norms influence intentions and subsequent behavior. The research team used an iterative rapid evaluation approach and matrix analysis to identify themes within each domain. Prompts to ask about smoking in the medical record and viewing smoking as harmful for Veterans’ health facilitated smoking discussion. Anticipating conversations about smoking to be uncomfortable or futile, managing competing priorities, and experiencing emotional discomfort during smoking discussions deterred such discussions. Interviews served as a source of reflection for providers, many of whom expressed motivation to discuss smoking more frequently. Education, training, and interactive support could help improve mental health provider confidence and comfort in delivering tobacco treatment in SMI clinics.