Background and challenges to implementation:
Smoking prevalence is five-times higher among Australian mental health consumers than the general population. Smoking cessation support is not routinely provided in community mental health services.

Intervention or response:
Cancer Council NSW's Tackling Tobacco program partners with not-for-profit community mental health services to assess opportunities for change and develop an action plan for systems change: data collection and monitoring; leadership; policy; supportive systems; staff training and provision of quit support. A simple survey-type tool was developed to identify opportunities for change and completed pre- and post-project to track progress. Pre- and post-surveys have been completed in 11 of services since 2014. Projects aim to achieve at least four systems changes across the six elements.

Results and lessons learnt:
100% of the 11 services where pre- and post-surveys were conducted have achieved at least four changes, such as developed a written smoking policy, trained staff, routinely recorded smoking status, and assisted consumers and staff to reduce or quit smoking. The six elements have clarified expectations for systems changes more specific practice guidelines have the potential to improve the quality of smoking care delivered and smoking outcomes for consumers further.

Conclusions and key recommendations:
Tackling Tobacco has successfully achieved systems changes in all mental health services. Future plans include developing evidence based guidelines to support systems change to address smoking in community mental health services. A consensus process and clustered randomised controlled trial is planned to validate the guidelines and the revised survey, set benchmarks for systems change to address each guideline, and to examine the effectiveness of the systems change intervention at reducing smoking rates amongst consumers attending community managed mental health services.