Smoking and mental health - NCSCT

Smoking and mental health
research evidence has shown that implementation of smoke-free policies in
mental healthcare settings is unlikely to result in deteriorations in mental state,
or increased levels of aggression, violence, use of seclusion, discharge against
medical advice or increased use of medication on an ‘as required’ basis. 7
Nevertheless, consideration should be given to the relative advantages and
disadvantages of implementation of smoke-free policies throughout all buildings
and grounds, or limiting implementation to buildings and allowing smoking in
all or selected outside areas (see Box 7.1 for examples). The successful smoke-free
implementation strategy at Rampton Hospital was based on earlier experiences
from mental health settings, and is summarised by Cormac and McNally. 10
When the smoke-free policy was introduced at Rampton Hospital, 73% of the
298 patients were smokers. A survey before policy implementation showed that
76% of nurses believed that patients would be more aggressive if they could not
smoke, 67% believed that self-harm would increase and 67% that patients would
need more medication. 11 After the policy was introduced, there was an increase
in untoward incidents in previous smokers at 3 months, but no increase in use of
seclusion or psychotropic medication, and no fire alarms attributable to
Box 7.1 Some advantages and disadvantages of
comprehensive and partial smoke-free policies
Comprehensive: buildings and grounds
Lower security risks, as patients are not
moving to other locations to smoke
Simple to implement as smoke-free areas
are defined by boundaries of the buildings
or grounds
Less risk of passive exposure for patients
and staff
Patients have to quit smoking completely if
they are unable to leave the forensic
psychiatric services
Smoking breaks for staff during work time
take longer, as staff have to leave the
grounds
Smoking by staff and visitors may be
displaced to public areas and can cause
nuisance
Partial: buildings only
Easier to enforce in settings with ready
access to secure grounds
Problems may occur if access to outdoor
areas is restricted
Increased costs of providing extra staff to
supervise outside smoking breaks
Risks for staff if isolated with patients
outside
Staff may be exposed to tobacco smoke
outside
Risk of fires increased if patients retain
tobacco and sources of ignition after
smoking breaks
Security risks from patients mingling in
groups outside
Patients are less likely to quit smoking, with
continuing health risks
132 © Royal College of Physicians 2013