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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    • "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. "

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    • "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 "
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    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.
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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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