SCEPTRE Feasibility Trial
Research type
Research Study
Full title
A randomised, controlled feasibility study of the SCEPTRE intervention to support smoking cessation and prevent relapse to tobacco use following a smoke free mental health inpatient stay
IRAS ID
329622
Contact name
Wendy Swann
Contact email
Sponsor organisation
Sheffield Health and Social Care NHS Foundation Trust
ISRCTN Number
ISRCTN77855199
Duration of Study in the UK
1 years, 1 months, 31 days
Research summary
The proportion of people with mental illness who smoke tobacco is very high compared to the general population. It can reach figures over 70% among those in certain subgroups, such as hospitalised patients with mental illness compared to 15% in the general population. As people with mental illness are usually heavily addicted to tobacco, smoking causes large amounts of disease and deaths in this group, often from cardiovascular, respiratory illness and cancer. Smoking has been recognised as the single largest cause of health inequalities for people with mental illness. People with mental illness lose up to 20 years of life mainly to the consequences of smoking. Although mental health patients often want to quit and can do so successfully, smoking is rarely addressed in mental health care. Guidance from the National Institute of Health and Care Excellence (NICE) recommends that mental health settings become entirely smokefree, and mental health patients should have access to evidence-based stop smoking treatment.
For many patients, receiving treatment in a smokefree inpatient environment will be a rare experience of abstaining from tobacco. Currently, no strategies to help maintain or achieve a smokefree lifestyle and avoid relapse post-discharge exist, meaning most patients will return to old smoking behaviours within days of discharge.
We have developed the SCEPTRE intervention to support mental health inpatients after discharge to maintain abstinence or positively change their smoking behaviour, building on existing evidence, behaviour change theory, and working closely with service users and mental healthcare professionals. The intervention was tested in a small-scale pilot study to test the research materials and processes, and preliminary acceptability to people with mental illness. Based on these findings, the SCEPTRE intervention has been revised and will be tested in the current feasibility trial.
Lay summary of study results: In the UK, people with mental health problems are significantly more likely to smoke than those without, increasing their risk of poorer physical health outcomes and shorter life expectancy. Although many people with mental health problems may want to quit, they often have less support to do so than the general population. The NHS set a goal for all mental health hospitals in England to become smokefree. Patients admitted to inpatient wards are encouraged and supported to reduce or quit smoking during their stay, often using nicotine replacement therapy (NRT) or e-cigarettes. While in hospital, many people express a desire to quit. Yet, most return to smoking soon after leaving hospital. The SCEPTRE programme was created to explore how best to support people at this critical transition point.
The SCEPTRE programme aimed to:
1. Work in partnership with patients, carers, staff and other stakeholders to co-produce a support package that was acceptable, practical, and evidence-based.
2. Test whether the package could be delivered in NHS mental health hospitals, and whether people would engage with and benefit from it.
3. Explore the challenges and opportunities for rolling out such support more widely across the NHS.
SCEPTRE was built on strong scientific foundations and included people with lived experience of mental health services working alongside researchers at every stage. Their voices were central in identifying what was needed. The programme drew on existing knowledge and a series of workshops and consultations were held with patients, carers, NHS clinicians, and tobacco experts to design the support package.
The resulting intervention was a 12-week support package that began before hospital discharge and continued into the community. Key components were:
• Goal-setting sessions: Up to two one-to-one sessions with a trained “My-Try Specialist” before leaving hospital, to plan personal quit goals and identify challenges.
• The My-Try Kit: A personalised set of resources including trackers, planners, journaling pages, quit tips, and links to digital support. The kit was designed to be practical, attractive, and user-friendly.
• Support with NRT and e-cigarettes: Guidance and access to pharmacological aids to help reduce cravings.
• Optional digital support: A mobile app and text messaging system offering reminders, motivation, and tips.
• Structured follow-up support: After discharge, participants were offered regular contact with support workers to check progress, provide encouragement, and troubleshoot difficulties.
The package was designed to provide continuous, personalised support at a time when people are most vulnerable to relapse.
We assessed the SCEPTRE intervention in a feasibility trial which was conducted across six NHS mental health trusts in England. The study recruited 38 patients from acute adult mental health wards who smoked before or during their hospital stay. Participants were randomly assigned to either receive the SCEPTRE package or continue with usual care. Follow-up data was collected from 20 participants at three months and again from 13 of these participants at four to six months after discharge. Biological, questionnaire and interview data were collected. This allowed the team to explore not only whether the package worked but also how it was experienced by those involved.
The findings were promising. Patients and NHS staff reported that the SCEPTRE package was acceptable, relevant, and helpful. The personalised My-Try Kit was particularly well liked, with participants appreciating its practical design and positive tone. Some participants in the intervention group successfully quit smoking, while none in the usual care group did. Others reported reducing the number of cigarettes smoked and feeling more confident about their ability to change. Interviews highlighted the importance of support during the transition from hospital. Staff valued having a structured package which complemented the smokefree hospital policy and filled a gap in post-discharge care.
However, there were challenges. Recruitment was more difficult than expected, partly due to the complexity of patients’ lives, staff capacity and a possible overestimation in how many mental health patients smoked. Following up participants after discharge was challenging. These difficulties meant that we could not recruit or follow up enough participants to justify progressing to a full trial.
SCEPTRE has shown that working with service users is possible and essential, and that tailored, practical support can make a real difference to people trying to quit smoking after hospital stays. The programme developed resources including training packages, videos, and patient-facing materials, that are now available for wider use. The project also provided valuable lessons about the barriers that need to be addressed in future research, such as how to maintain contact with patients after discharge and how to integrate support into busy clinical pathways.REC name
North West - Greater Manchester West Research Ethics Committee
REC reference
23/NW/0312
Date of REC Opinion
13 Oct 2023
REC opinion
Favourable Opinion