Smoking and mental health - NCSCT

Smoking and mental health
a pervasive culture of smoking in many mental health settings. In either case the
paramount importance of all healthcare professionals taking the opportunity to
address smoking in people with mental disorder is evident. Mental health
facilities need to become comprehensively smoke free, in grounds as well as
buildings, for all staff, visitors and patients. Abstinence from smoking, through
cessation or harm reduction, needs to be established as the prevailing culture.
Smoke-free policies work if comprehensive and delivered with appropriate
leadership, training and support strategies for patients and staff. Investment in
achieving smoke-free mental health settings, and in the support needed by
patients and staff to allow this to happen, is therefore an urgent national
priority.
10.6 Special circumstances
Smoking, and particularly high levels of nicotine dependence, are especially
common among people admitted to forensic psychiatric facilities and for many
years was culturally entrenched in the working of these facilities. Since 2007 this
has changed, radically. Rampton Hospital, and subsequently all high-secure units
in the UK, has successfully implemented comprehensive smoke-free policies
throughout their buildings and grounds. Contrary to expectation, this has been
achieved without significant adverse effects. Strong leadership, clear policies and
provision of cessation support for patients and staff are among the perceived
determinants of success. The experience of these institutions indicates clearly
that, with similar determination, mental health facilities for the wider population
with mental disorders can also become smoke free.
Smoking is also common among other population groups with a particularly
high prevalence of mental disorders, including prisoners, homeless people, and
people dependent on alcohol or other drugs. As in the wider mental health
population, these smokers are no less likely to want to quit smoking than those
in the general population, but they are more likely to be highly dependent, to
be exposed to an institutional or facility culture in which smoking is engrained,
and, perhaps as a result, quit attempts are less likely to succeed in this group. In
drug dependence treatment facilities, addressing smoking probably improves,
rather than reduces, the effectiveness of treatments for dependence on other
drugs. Recent experience from New Zealand demonstrates that prisons can
become smoke free, without major adverse effects, and that half of prisoners
who quit smoking while in prison intend to remain non-smokers after release.
Establishment of smoke-free cultures in facilities for homeless people or those
with other drug dependence is likely to be equally important and effective in
promoting smoking cessation. The experience of high-secure units in Britain,
and prisons in New Zealand, demonstrates that such culture changes can be
achieved, to widespread benefit. The National Offender Management Service
for England and Wales is working towards making all prisons smoke free,
192 © Royal College of Physicians 2013