Article

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

ABSTRACT

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.

Download full-text

Full-text

Available from: Rene Pols
  • Source
    • "Recent studies demonstrate that the introduction of smoking bans in psychiatric and addiction inpatient settings is possible [37,38], but they 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 [20]. The poor abstinence rates in tobacco after discharge, although patients received specific treatment for smoking abstinence makes clear that it could be important design and provide a specific treatment for nicotine dependence after acute detoxification to prevent new relapses. "

    Full-text · Article · Dec 2015
    • "Schultz, Finegan, Nykiforuk, and Kvern (2011) state that responsibility becomes distorted when smoking is viewed as a morally interpreted behaviour, a 'lifestyle choice,' rather than an addiction that requires support. Many researchers have stated that if smoking is framed as an addiction, then service providers may be more inclined to become involved and provide treatment for withdrawal symptoms (Bell et al., 2011; Lawn & Pols, 2005; National Institute for Health and Care Excellence, 2013; Prochaska, 2011). Had participants chosen to view smoking as an addiction, coupled with the absence of adequate "
    [Show abstract] [Hide abstract]
    ABSTRACT: Few researchers have explored family carers’ perspectives of smoking by their family members with mental illness, despite smoking rates remaining high for people with mental illness. In-depth qualitative interviews with twelve South Australian family carers explored their experiences and views of providing care for people with mental illness who smoke. Data were analysed thematically. Around the central theme of the caring role within the context of mental illness and smoking, were three interrelated themes: (1) responsibility; (2) accommodation; and, (3) dissonance. Carers struggled physically, philosophically and emotionally with perceived responsibilities involving their family member's smoking. They felt isolated and asserted as there was limited support from service providers to assist them. Carers are important agents within the person's immediate environment who could potentially help them to improve their smoking cessation success. Community services aiming to support smoking cessation support for this population need to incorporate the role of family carers.
    No preview · Article · Oct 2015
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Mar 2014 · BMC Psychiatry
Show more