CHOICES 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 University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School-Division of Addiction Psychiatry (UMDNJ-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, joined the team in May of 2005 as the Program Director. 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. In her role, she manages many of the day to day operations and helps 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 the 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 UMDNJ-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.

HIRING OUR TWO ADVOCATES
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.

NEWSLETTER

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.

WEBSITE
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.