Smoking and mental health - NCSCT

7
Smoking and mental disorders:
special circumstances
The individual and population measures to prevent smoking uptake, and
promote and support quitting, summarised in Chapters 5 and 6, are general
approaches that apply across the spectrum of the population of people with
mental disorder who smoke. This chapter addresses the special considerations
relating to applying some of these measures, and particularly smoking cessation
and smoke-free policy, in settings or populations that present particular
challenges, or may require more tailored approaches. These comprise forensic
psychiatric inpatient settings, prisons, people who misuse alcohol or other drugs,
homeless individuals, pregnant women, and children and adolescents. Evidence is
drawn primarily, but not exclusively, from UK sources.
7.1 Forensic psychiatric inpatient services
7.1.1 Introduction
Forensic psychiatric services provide psychiatric care to offenders with mental
disorders, and to people with challenging behaviours that cannot be safely
managed elsewhere. Patients are usually detained under mental health legislation
or under a hospital order, with or without restriction, by the Ministry of Justice,
or under legislation pertaining to other jurisdictions of the UK. About 4,000
people are detained in forensic services in the UK and, in a recent survey of
forensic psychiatric service inpatients, over three-quarters had a diagnosed
mental illness, with or without other mental disorders (the remainder being in
the process of assessment for mental disorder); 1 over 50% of patients were
transferred prisoners from local (remand) prisons, and over a third (36%) had
committed crimes involving violence against the person. 1
The aim of forensic psychiatric services is therapeutic and not punitive.
However, security measures are necessary to manage risk and prevent escape;
these vary from high to medium and low levels, and include physical structures,
general policies and procedures, and relational security. 2 Healthcare staff are
responsible for maintaining safety and security, and for delivering therapies to
treat mental disorders and reduce the risk of reoffending.
130 © Royal College of Physicians 2013