Smoking and mental health - NCSCT

Smoking and mental health
not willing to question or undermine. There is also a widespread perception that
smoking is of less immediate importance than other needs and priorities,
particularly when patients are acutely unwell. 75,91
Attitudinal differences between mental health staff according to smoking status
and professional group have also been reported, with smokers being significantly
more likely than non-smokers to believe that patients should be allowed to
smoke with staff, to refer to smoking as a means of forming a therapeutic
relationship, and less likely to think that patients who smoked should be
encouraged to cut down or quit smoking. 93 In one British study, staff who
smoked were found to be less concerned about the effects of smoking on staff
and patients, 94 and nursing staff, irrespective of their smoking status, were less
likely than psychiatrists to believe that patients should be encouraged to stop
smoking, and more likely to think that smoking had value in terms of forming a
therapeutic relationship. 94 Furthermore, independent of smoking status or
professional group, staff believed that patients would become agitated or their
mental health would deteriorate if they could not have cigarettes, 94 and a
majority, including doctors, felt that smoking was an important coping
mechanism that helped patients to deal with their mental illness. 95 Overall,
smoking-related interventions are significantly less popular among mental health
staff than among other healthcare professionals. 96
6.4.3 Staff knowledge
Apart from attitudinal stances that may help or hinder engagement with smoking in
mental health settings, it is also clear that knowledge relating to tobacco dependence
and its specific links with mental illness, as well as behavioural support skills, are
paramount to ensuring that smoking is addressed adequately. Such knowledge and
skills are sometimes lacking. A survey of all clinical staff working in 25 adult mental
health inpatient wards in England’s largest mental health trust found that
knowledge of tobacco dependence was limited across all staff groups including
doctors, with clinically important facts, eg the need to monitor antipsychotic
medication after smoking cessation, not widely known. 95 Misconceptions, such as
the belief that nicotine constitutes the carcinogenic component in tobacco smoke,
were also frequent (36%). 95 These findings indicate that the often limited support
smokers receive on inpatient wards is further compromised by serious deficiencies
in the knowledge of clinical staff, and therefore that appropriate training for staff on
smoking interventions and culture is an important priority. 95
6.4.4 Staff smoking
Tobacco smoking among nurses has been called both a ‘contentious issue’ and a
‘conundrum’. 97 Contrary to expectation, smoking prevalence among nurses, who
122 © Royal College of Physicians 2013