Smoking and mental health - NCSCT

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Smoking and mental health unemployment, long-term disengagement from health and other services, and poor relationships with those who might help them. 44 Time in prison therefore presents a significant opportunity for smoking prevention and other health interventions among this otherwise hard-to-reach, disadvantaged and often otherwise neglected group. 45 The motivation for prisoners to smoke is often linked to coping with the prison environment. Many prisoners smoke to relieve boredom or stress attributed to prison life, 26,47–49 but in practice smoking also arises from nicotine withdrawal, or because of peer-group pressure or the association with illegal drug use. Prisoners have reported feeling a stronger need to smoke while imprisoned, 3 while boredom, being confined to cells for long periods and stress have also been cited as reasons for relapse by prisoners who have made quit attempts while in prison. 50 As a male prisoner in an English category C prison remarked, tobacco is ‘everybody’s lifeline in here’. 21 Smoking habits also change in prison, both positively and negatively. The limited access to tobacco, in combination with other factors, may contribute to reductions in the amount of tobacco smoked and/or the frequency of smoking. 35,36 However, the high prevalence of smoking among other inmates can promote smoking, as, for example, in a US female prison in which 14% of prisoners started smoking for the first time and more than 50% increased their smoking after entering prison. 51 7.2.3 Smoke-free policy in prisons Smoke-free policies are intended primarily to protect prisoners and staff from passive smoke exposure, but, as in general society, also reduce the general acceptability and normality of smoking and hence support smoking prevention. Given the high prevalence of smoking among prisoners, passive smoke exposure in prisons can be extremely high; indeed, one study estimated that more prisoners in the USA die from exposure to second-hand smoke every year than from the death penalty. 52 As a result many countries, including most European Union member states, now impose restrictions on smoking in common areas in prisons, whereas in many parts of the USA smoking in prison is completely prohibited. 25,32 In New Zealand, all prisons became completely smoke free inside their secure perimeter on 1 July 2011, after a 12-month lead-in period and with free access to NRT for prisoners. Implementation is reported to have been successful, with no incidents of related violence, reported improvements in tensions between prisoners and staff, and with half of those who smoke stating that they intend to remain non-smokers after release. 53 Smoke-free legislation was introduced in prisons in Scotland in 2005, and broadly similar measures in England and Wales and Northern Ireland in 2007; the Prison Service Instruction (PSI) 09/2007 for England requires all indoor areas of prisons to be smoke free with the exception of cells occupied solely by smokers aged 18 and over. 54 The Prison Officers Association has since called for 136 © Royal College of Physicians 2013
Smoking and mental disorders: special circumstances 7 more rigorous restrictions on health and safety grounds, 55 claiming that the PSI does not provide protection for officers when they enter cells. Establishments holding people aged under 18 years must have an entirely smoke-free environment within their buildings, 54 and most extend this to outside areas within the prison walls. Hence, Her Majesty’s Young Offender Institutions (HMYOIs) which admit only juveniles, such as Wetherby, Hindley and Ashfield, are completely smoke free. In addition, one adult prison on the Isle of Man has been fully smoke free since opening in 2008. 7.2.4 Effectiveness and uptake of cessation services in prisons Studies across a range of criminal justice settings in different countries have identified high levels of desire among offenders to quit smoking, and to receive support to do so. 9,28,34,37,39,56–58 Prisoners have described imprisonment as an opportunity to access smoking cessation support and NRT, 47 and qualitative findings demonstrate that many British prisoners want to ‘achieve something’ while in prison and view quitting smoking as a big achievement. 49 In an evaluation of NRT-based smoking cessation initiatives across 15 prisons in the north-west of England in 2004–5, 49 41% of prisoners using the service quit for at least 4 weeks, comparable to quit rates in local disadvantaged populations at that time, whereas recent data on prisoners from the English NHS stop smoking services suggest a 4-week quit rate of around 55%. 59 These proportions are broadly similar to those achieved by NHS cessation services in general, as is the proportion of smokers using prison cessation services, at around 12% in 2010–11. 59 A recent pilot study exploring barriers and facilitators to the implementation of smoking cessation support across prisons in England 60 concluded that the prison service provides a generally favourable context for smoking cessation support and an important means of accessing hard-to-reach groups, but that the availability of a professional coordinator improved smoking cessation support in prisons and other criminal justice settings. 7.2.5 Design of prison cessation services A range of smoking cessation delivery models, typically offering individual and/or group behavioural support, together with pharmacotherapy, have been used in criminal justice settings. 27,49,51,61–63 Although group therapy may be more effective in the general population of smokers, one-to-one services are sometimes required for reasons of security, and for prisoners who have difficulty coping with group dynamics. A study of 15 prisons in the north-west of England found that 9 offered both group and one-to-one support, 3 group support only and 3 one-to-one support only, all in conjunction with NRT. 49 In one British prison, ‘rolling’ groups were found to reduce waiting times for cessation © Royal College of Physicians 2013 137
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PDF not for circulation Smoking and
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Contents Members of the Tobacco Adv
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Contents 4.4.3 Attention deficit hy
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Contents 6.4.3 Staff knowledge 122
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Contents 10.5 Tobacco policy and me
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Contributors Anthony Aclet - Specia
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Contributors Jill Williams - Associ
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1 Mental disorders 1.1 What is a me
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Mental disorders 1 1.3 Common menta
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Mental disorders 1 1.4.4 Somatisati
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Mental disorders 1 In addition to s
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Mental disorders 1 not diagnosed un
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Mental disorders 1 Similar to many
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Mental disorders 1 12 Chang CK, Hay
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Mental disorders 1 52 Young S, Toon
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Smoking among people with mental di
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Neurobiological and behavioural mec
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Ethical and legal aspects 9 patient
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10 Summary and conclusions 10.1 Smo
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Summary and conclusions 10 10.4 Smo
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Summary and conclusions 10 although
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11 Key conclusions and recommendati
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Key conclusions and recommendations
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