Smoking and mental health - NCSCT

Smoking and mental health
support. 61 Prisons also differ over use of trained in-house prison service staff or
specialists from community-based services to deliver support. In Scotland,
smoking cessation is part of the work of the Enhanced Addictions Casework
Service (EACS – equivalent of CARATS in England: Counselling: Assessment,
Referral, Advice, Throughcare), undertaken by healthcare staff. There is no
conclusive evidence on the relative effectiveness of these different approaches.
Smoking cessation support materials for use in prisons need to take account of
prevalent low levels of literacy, eg by the use of audiovisual materials. 61
7.2.6 Regime issues
The movements of offenders within the criminal justice system can be a barrier
to accessing smoking cessation services and to their success. 49,64 Transfers to
other prisons are stressful and disrupt provision of behavioural support and
pharmacotherapy. 49,50 Smoking cessation initiatives should therefore plan for the
likelihood of transfers 50 by ensuring that medical records are transferred with
prisoners, and a short supply of pharmacotherapy is provided to cover the
interval until prescribing can be renewed at the new location. 49 It has been
suggested that access to telephone counselling or quitlines may also help to
overcome disruption to cessation service access associated with transfers. 26,64
Release from prison can also obstruct the continuation of cessation support. As
the post-release period is in any case a potentially challenging and stressful time
of re-adjustment, relapse among those who have quit smoking while in prison
may be particularly likely in this period. A US study of prisoners released from a
tobacco-free correctional facility found that only 18% remained abstinent at the
end of the first week after release. 65 Prison services may therefore need to link
with community smoking cessation programmes to ensure support for prisoners
after release. 26,61
7.2.7 Staff attitudes and logistics
Negative staff attitudes to smoking cessation initiatives, 49 and a high prevalence
of smoking among prison staff, 61 can be significant barriers to smoking cession
in prison, as is the use of cigarettes, documented in a forensic psychiatry
facility, 62 by staff as a reward or incentive to control behaviour. Engagement of
prison staff in support of quit programmes, and promoting cessation among
staff, is therefore important. 49,64 Delivery of smoking cessation initiatives in the
criminal justice system can also place a substantial burden on prison staff who
may be required to manage waiting lists, organise prescriptions and other
paperwork, distribute nicotine patches and provide ad hoc support to quitters. 66
To be sustainable, cessation services in prison need to take account of these
additional demands on resources.
138 © Royal College of Physicians 2013