Smoking and mental health - NCSCT

Smoking and mental disorders: special circumstances 7
7.1.2 Smoking prevalence in forensic psychiatric services
Reported smoking rates in forensic psychiatric services inpatients have been very
high, at over 70% in one high-secure hospital, 3 and more than 80% in mediumsecure
settings 4,5 in England. As in other mental health settings, the high prevalence
of smoking in forensic psychiatric services may reflect the patients’ perceived need
for self-medication, void filling and cultural pressure. 6 Patients in these settings may
experience psychiatric symptoms, including those of mood disturbance and
psychosis, and may use smoking to distract from or ‘medicate’ against such
symptoms. Smoking can also be perceived as ‘something to do’ during prolonged
periods of inactivity and boredom resulting from restrictions on movement and
other security controls. Cultural aspects of the forensic psychiatric setting may also
add value to smoking as a substitute currency, or if smoking is used to reward good
behaviour or to facilitate engagement with patients 7 (see also Chapter 6).
7.1.3 Smoking cessation support within forensic psychiatric services
Guidance on stop smoking support programmes within mental healthcare
settings recommends the routine delivery of brief interventions that feed into
intensive, multi-sessional smoking cessation programmes delivered by suitably
trained advisers. 6 In some respects, forensic psychiatric settings are particularly
suitable for such interventions because long periods of admission provide time
for patients to plan and implement smoking cessation, in close proximity to staff
able to provide support throughout the quitting process. Smoke-free policies are
crucially important to promoting cessation, as patients have reported high
perceived levels of difficulty in stopping smoking when regularly exposed to
other patients and staff smoking. 8 Overall the general points on smoking
cessation provision for people with mental disorders, outlined in Chapter 5, also
apply in this setting, although with the proviso that they must be compliant with
security restrictions.
7.1.4 Smoke-free policies in forensic psychiatric services
In the UK, smoke-free legislation prohibited smoking in most enclosed public
areas or workplaces in 2007, and in mental healthcare settings from 2008. In
2007, Rampton Hospital was the first high-secure hospital in the UK to become
smoke free in buildings and grounds. Since then Ashworth and Broadmoor
Hospitals in England and The State Hospital in Scotland have become completely
smoke free. Some medium-secure services permit smoking in the grounds but
not in the buildings, whereas others are totally smoke free.
Staff attitudes to smoke-free policies in mental health settings before smokefree
policy implementation have often been negative. 9 However, review level
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