Smoking and mental health - NCSCT

Smoking and mental health
smoking materials into the hospital. Carbon monoxide breath testing can be used
to check whether a patient has recently been smoking. All new patients admitted
to a smoke-free site must be informed that the hospital is smoke free and that
smoking cessation support is available from ward staff trained in smoking
cessation techniques. Management should ensure that sufficient staff are trained
to support patients with smoking cessation, particularly on admission wards.
Untoward incidents should be recorded and reported by staff according to
standard protocols, and security incidents and violent incidents in forensic secure
settings reported to the management, security department and clinical
governance teams.
7.1.6 Summary points
> Smoke-free policies can be implemented successfully in secure forensic
psychiatric settings.
> Key determinants of success include strong leadership, clear policies and
communications, staff training and prescription of cessation
pharmacotherapy in advance of implementation and afterwards.
> Well-managed smoke-free policies and adequate patient support can help to
reduce risk to patients and staff in forensic psychiatric services.
7.2 Prisons
7.2.1 Introduction
There are 139 prisons in England and Wales, varying in capacity and security
level from category A (highest) to category D (lowest) security risk. The category
of prison to which offenders are allocated is determined by the crime committed,
the likelihood of an attempt to escape and the attendant risk of harm to the
public, and the length of the sentence remaining. Approximately 132,000 people
pass through the prison system each year in England and Wales, with around
85,000 being held in prisons at any time. Some 95% of these are men, and most
are under 30 years of age. 17
Prisons exist to punish criminals, separate them from society, and correct
and in due course rehabilitate them into the community. 18 Prisons also
present challenges to health and wellbeing including: overcrowding, lack of
purposeful activity and of mental and physical stimulation; fear, anxiety and
mistrust; physical, emotional, sexual and financial exploitation; separation
from family networks; and often inadequate medical care with an
overemphasis on medication. 19–22 Prisons have entrenched cultures that shape
the social relationships between prisoners, and between prisoners and
staff. 21,23,24
134 © Royal College of Physicians 2013