Smoking Bans in Psychiatric Inpatient Settings? A Review of the Research

Division of Mental Health/Finders Medical Centre, South Australia.
Australian and New Zealand Journal of Psychiatry (Impact Factor: 3.41). 11/2005; 39(10):866-85. DOI: 10.1111/j.1440-1614.2005.01697.x
Source: PubMed


This paper reviews the findings from 26 international studies that report on the effectiveness of smoking bans in inpatient psychiatric settings. The main aim is to identify which processes contribute to successful implementation of smoking bans and which processes create problems for implementation in these settings.
After performing an electronic search of the literature, the studies were compared for methods used, subjects involved, type of setting, type of ban, measures and processes used and overall results. Total bans were distinguished from partial bans. All known studies of smoking bans in psychiatric inpatient units from 1988 to the present were included.
Staff generally anticipated more smoking-related problems than actually occurred. There was no increase in aggression, use of seclusion, discharge against medical advice or increased use of as-needed medication following the ban. Consistency, coordination and full administrative support for the ban were seen as essential to success, with problems occurring where this was not the case. Nicotine replacement therapy was widely used by patients as part of coping with bans. However, many patients continued to smoke post-admission indicating that bans were not necessarily effective in assisting people to quit in the longer term.
The introduction of smoking bans in psychiatric inpatient settings is possible but would need to be a clearly and carefully planned process involving all parties affected by the bans. Imposing bans in inpatient settings is seen as only part of a much larger strategy needed to overcome the high rates of smoking among mental health populations.


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    • "Such a finding suggests an increase in nicotine dependence treatment had occurred in the period following the introduction of the smoke-free policy [23]. An increase in nicotine dependence treatment provision has similarly been reported in a number of other studies following the implementation of smoke-free policies [13]. "
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    ABSTRACT: People with a mental illness experience a higher burden of smoking-related disease. Smoke-free policies in mental health facilities provide an opportunity to reduce smoking-related harms for patients and staff alike. Limited evidence regarding the effect of such policies on preventing smoking in mental health facilities has been reported. The aims of this study are to describe the extent of smoking and the provision of nicotine replacement therapy (NRT) to patients in a mental health facility with a smoke-free policy. Cross-sectional studies of smoking (cigarette butt count and observed smoking) and nicotine dependence treatment (patient record audit) were undertaken over 9 consecutive weekdays in one mental health facility in Australia. A smoke-free policy incorporating a total smoking ban and guidelines for treating nicotine dependence among patients was implemented in the facility 4 years prior to the study. Two thousand one hundred and thirty seven cigarette butts were collected and 152 occasions of people smoking were observed. Staff members were observed to enforce the policy on 66% of occasions. Use of NRT was recorded for 53% of patients who were smokers. Implementation of the smoke-free policy was less than optimal and as a consequence ineffective in eliminating smoking and in optimising the provision of NRT. Additional strategies to improve the provision of nicotine dependence treatment to patients and the monitoring of adherence are needed to ensure the intended benefits of smoke-free policies are realised.
    BMC Psychiatry 03/2014; 14(1):94. DOI:10.1186/1471-244X-14-94 · 2.21 Impact Factor
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    • "Finally, there are other additional barriers to quitting smoking that people with psychosis experience compared to smokers in the general population, which may account for the different pattern of smoking outcome results. These include low levels of confidence and self-efficacy in relation to quitting among smokers with psychosis (Filia et al., 2011), smokers with psychosis not being routinely offered smoking cessation interventions (Baker et al., 2010), the reinforcement of smoking among their social and treatment networks (Lawn and Pols, 2005), the reduced impact of anti-smoking campaigns for people with psychosis (Thornton et al., 2011), and that nicotine can transiently improve some of the cognitive deficits evident in psychosis (Dolan et al., 2004). Some of the gender differences identified in this study are consistent with those previously identified among smokers in the general population. "
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    ABSTRACT: While research has identified gender differences in characteristics and outcomes of smokers in the general population, no studies have examined this among smokers with psychosis. This study aimed to explore gender differences among 298 smokers with psychosis (schizophrenia, schizoaffective and bipolar affective disorder) participating in a smoking intervention study. Results revealed a general lack of gender differences on a range of variables for smokers with psychosis including reasons for smoking/quitting, readiness and motivation to quit, use of nicotine replacement therapy, and smoking outcomes including point prevalence or continuous abstinence, and there were no significant predictors of smoking reduction status according to gender at any of the follow-up time-points. The current study did find that female smokers with psychosis were significantly more likely than males to report that they smoked to prevent weight gain. Furthermore, the females reported significantly more reasons for quitting smoking and were more likely to be driven by extrinsic motivators to quit such as immediate reinforcement and social influence, compared to the male smokers with psychosis. Clinical implications include specifically focussing on weight issues and enhancing intrinsic motivation to quit smoking for female smokers with psychosis; and strengthening reasons for quitting among males with psychosis.
    01/2014; 215(3). DOI:10.1016/j.psychres.2014.01.002
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    • "Smoke-free policy implementation in mental health inpatient settings comes as a result of a wider move to ban smoking in hospitals and health services to reduce risks to staff and patients from environmental tobacco smoke [8]. Mental health facilities have been slower than other parts of the health service to implement total bans due to concerns including anticipated increases in aggression, symptom and behaviour management and patient rights issues [8,10-12]. "
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    ABSTRACT: Background In 2008, a new forensic hospital was opened as a totally smoke-free facility. This study describes the attitudes and experience of mental health professionals working in the high secure mental health facility three years after it was opened. It is part of a larger evaluation describing the experience of current and discharged hospital patients. Methods Quantitative data was collected using a survey of hospital staff (N = 111) with a 50% response rate. The survey collected demographic and smoking data to describe staff responses to statements relating to hospital smoking policy, patient care and staff support. Results Among staff surveyed, 13% were current smokers and 41% were ex-smokers (10% quit after commencing employment in the smoke-free hospital). Most (88%) preferred to work in a smoke-free environment, although this was significantly lower in smokers compared to non-smokers (39% vs. 95%). While most staff felt that the smoke-free environment had a positive impact on the health of patients (86%) and on themselves (79%), smokers were significantly less likely to agree. Just over half (57%) of staff surveyed agreed that patient care was easier in a totally smoke-free environment, although less smokers agreed compared to non-smokers. Staff who smoked were also significantly less likely to indicate they had sufficient support working in a smoke-free environment, compared to non-smokers (15% vs. 38%). Conclusions The staff surveyed supported the smoke-free workplace policy; most agreed that patient care was easier and that the policy did not lead to an increase in patient aggression. Implementation of a total smoking ban can result in positive health outcomes for patients and staff, and may influence some staff to quit. Staff who smoke have a less positive experience of the policy and require additional support.
    BMC Public Health 04/2013; 13(1):315. DOI:10.1186/1471-2458-13-315 · 2.26 Impact Factor
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