Observation of the extent of smoking in a mental health inpatient facility with a smoke-free policy.

Paula Wye,Sharon Lawn,Jenny Bowman,Leanne Beth Gow,Jude Constable,John Wiggers

doi:10.1186/1471-244x-14-94

Abstract

BackgroundPeople 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.MethodsCross-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.ResultsTwo 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.ConclusionImplementation 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.

Highlights

People with a mental illness experience a higher burden of smoking-related disease
Past evaluation of the impact of such policies has primarily involved measurement of staff perceptions regarding the enforcement of such policies and the impact of such policies on the provision of psychiatric care, rather than on either the elimination of smoking within facilities, or the provision of nicotine replacement therapy (NRT) [5,13,15,16,17]
Setting A cross-sectional study was conducted in a single mental health inpatient facility in the state of New South Wales, Australia

Summary

Introduction

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. People with a mental illness experience a higher burden of smoking-related disease, a key factor in their having a markedly shorter life expectancy [1,2]. This inequitable disease burden is in part a function of a greater prevalence of smoking, one that is at least double that of the general population [3,4]. The use of nicotine replacement and other pharmacotherapies are effective in aiding the management of nicotine withdrawal and in aiding smoking cessation [6] Of the limited number of studies that have directly measured impact on the prevalence of smoking, continued smoking within facilities has been a commonly reported finding [13,17]

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