Electronic cigarettes in mental health settings – solving a conundrum?

Elena Ratschen

doi:10.1192/pb.bp.114.047431

Abstract

Electronic cigarettes (e-cigarettes), have recently been the focus of much attention and debate. This article attempts to highlight their relevance and potential importance for mental health settings, with a focus on in-patient units. To do so, the complexities involved in smoking among people with mental disorder, the debate surrounding e-cigarettes, and their potential to be utilised as a smoking cessation or temporary abstinence aid in the context of smoke-free policies and new National Institute for Health and Care Excellence guidance for smoking cessation in mental health settings, will be discussed and synthesised below.

Highlights

How could e-cigarettes be of particular value in mental health settings? Many trusts are currently confronted with what must feel like a conundrum: there is all the good will to make mental health settings completely smoke free, to offer smokers gold standard support, to work towards closing the gap between smokers with mental disorder and smokers without by changing the persistent smoking culture in these settings - and yet, there is not much wisdom as to how to achieve this
Generally speaking, treatments for tobacco dependence that work for the general population work for people with mental illness,[18] certain caveats with regard to the use of bupropion and varenicline apply.[1,18]. The evidence supporting this stems from clinical trials that recruited particular subgroups of smokers with mental disorder: those who were stable, usually living in the community and who were, above all, willing to address their smoking and consent to being part of smoking research in the first place
Pilot research on in-patient units has demonstrated that the mantra of offering NRT and specialist smoking cessation advice in everyday practice results in modest success rates in terms of service uptake and smoking cessation or abstinence.[14]

Summary

Introduction

Many trusts are currently confronted with what must feel like a conundrum: there is all the good will to make mental health settings completely smoke free, to offer smokers gold standard support, to work towards closing the gap between smokers with mental disorder and smokers without by changing the persistent smoking culture in these settings - and yet, there is not much wisdom as to how to achieve this.

Results

Conclusion