“The first pack I bought were Winstons,” he said, with what seemed like a wistful half-smile. “The first cigarette I ever smoked was a Kool Super Menthol. That was back in 1975. It cost 50 cents a pack.”
Today, a pack of cigarettes costs much, much more than that, but Bart, a 10-year member of Mental Health Resources’ Seward Community Support Program (CSP), a drop-in community center providing socialization and services for people with serious and persistent mental illness, still smokes, as much as a pack a day. (Though he agreed to have his photo taken for this story, Bart did not want to use his last name.)
Bart usually spends about three hours a day at Seward CSP; when he’s not busy manning the center’s front desk, doing dishes, serving lunch, using the center’s free computers or playing pool with his friends, he liked to hang out on the program’s front patio facing Minnehaha Avenue, enjoying a cigarette.
No matter the weather, Bart rarely had the patio to himself: A significant percentage of Seward CSP’s more than 385 members are tobacco users, said Ann Henderson, Mental Health Resources vice president of clinical services.
Nicotine addiction “disproportionately impacts people with mental illness,” Henderson explained. One in three adults with mental illness smoke, she said, compared to one in five adults without mental illness. In 2016, 54 percent of people receiving services from Mental Health Resources identified as smokers. That same year, 14.4 percent of all Minnesota adults identified as smokers.
This disproportionate rate of addiction, combined with the fact that tobacco companies historically marketed their products to people with mental illness and their health care providers, has inspired change.
Last November, Mental Health Resources, along with two more of Minnesota’s largest behavioral health organizations — People Incorporated and Avivo — announced that they would be banning tobacco at all of their facilities. The ban — for clients and employees — went into effect July 30 at Avivo and Mental Health Resources.
At Seward CSP, this meant that smoking would no longer be allowed on the patio.
For Bart, the day the tobacco ban went into effect was “no big deal.” He’d known that the plan was in the works for months, and he’d prepared for it, by attending a few of the smoking cessation groups offered at the center, stocking up on the Nicorette gum that was offered free of charge to anyone interested in cutting back and scoping out good “off-campus” spots to smoke. (“I don’t want to quit completely,” Bart said. “But I do want to cut back.”)
Even for a confirmed smoker like Bart, tobacco bans are “a good thing,” he said. “Little by little the counties in Minnesota are all going smoke-free. You can’t smoke in restaurants or most public places. I’m starting to get the hint.” And, as a person who’s naturally suspicious of the motivations of government and big business, he added: “I think about how the cigarette companies are putting dangerous chemicals into our bodies and it makes me angry.”
All this adds up to Bart becoming an unlikely supporter of Seward CSP’s tobacco ban.
“I’m all for it,” he said. “The more people go tobacco-free, the less they are going to smoke.”
Henderson chalks getting people like Bart on board with the tobacco ban to careful planning and strategy. For a few years before they even mentioned the ban to staff and clients, managers from the group of three nonprofits met with representatives from the American Lung Association to design a plan that would increase buy-in and make the tobacco-free transition as seamless as possible.
“Early on, we started our communications by saying, ‘This is where we’re headed. It is going to impact all of us,’” Henderson said. There were some people who were worried and concerned, she added, but organizers explained that it would be a long-term project. “Most of the people we serve said, ‘That makes a lot of sense. I’m surprised you haven’t done this before.’ They’re used to it. They go lots of places where they are not allowed to use tobacco.”
One strategy that organizers employed was gathering resources for staff and clients who were interested in quitting.
“We’ve done a lot of treatment interventions for them, including forming groups to help people learn coping techniques other than using tobacco,” she said. “We’re not saying anyone has to quit tobacco. If you do want to quit, we have provided a lot of different options for you.”
Options included “support stations,” with free sample packs of nicotine-replacement lozenges, gum and patches.