Smoke-free Mental Health Research Articles

Promoting and Maintaining Changes in Smoking Behavior for Patients Following Discharge from a Smoke-free Mental Health Inpatient Stay: Development of a Complex Intervention Using the Behavior Change Wheel.

Evidence suggests that smokers can successfully quit, remain abstinent or reduce smoking during a smoke-free mental health inpatient stay, provided behavioral/pharmacological support are offered. However, few evidence-based strategies to prevent the return to prehospital smoking behaviors post-discharge exist. We report the development of an intervention designed to support smoking-related behavior change following discharge from a smoke-free mental health stay. We followed the Behavior Change Wheel (BCW) intervention development process. The target behavior was supporting patients to change their smoking behaviors following discharge from a smoke-free mental health stay. Using systematic reviews, we identified the barriers and enablers, classified according to the Theoretical Domains Framework (TDF). Potential intervention functions to address key influences were identified by consulting the BCW and Behavior Change Technique (BCT) taxonomy. Another systematic review identified effectiveness of BCTs in this context. Stakeholder consultations were conducted to prioritize and refine intervention content. Barriers and enablers to supporting smoking cessation were identified within the domains of environmental context and resources (lack of staff time); knowledge (ill-informed interactions about smoking); social influences, and intentions (lack of intention to deliver support). Potential strategies to address these influences included goal setting, problem-solving, feedback, social support, and information on health consequences. A strategy for operationalizing these techniques into intervention components was agreed upon: Pre-discharge evaluation sessions, a personalized resource folder, tailored behavioral and text message support post-discharge, and a peer interaction group, delivered by a trained mental health worker. The intervention includes targeted resources to support smoking-related behavior change in patients following discharge from a smoke-free mental health setting. Using the BCW and TDF supported a theoretically and empirically informed process to define and develop a tailored intervention that acknowledges barriers and enablers to supporting smoking cessation in mental health settings. The result is a novel complex theory- and evidence-based intervention that will be formally tested in a randomized controlled feasibility study.

Smokefree mental health inpatient settings – a matter of debate?

Abstract. Background: The prevalence of tobacco smoking among people with severe mental illness (SMI) substantially exceeds smoking rates in the general population and has been identified as the largest contributor to health inequalities in this group. Historically deeply embedded in the culture of mental health treatment environments, smoking until very recently was the norm in inpatient settings and still prevails in many settings internationally. In England however, mental health Trusts are currently implementing recent national guidance, according to which mental health settings will become entirely smokefree, with no exemptions, providing comprehensive evidence-based support to patients for smoking cessation and smoking abstinence during the inpatient stay. Aim: The aim of this article is to summarise the rationale for and the debate surrounding smokefree mental health inpatient settings, and to review and discuss the evidence on challenges, opportunities and impact of smokefree policy implementation in these settings, with a focus on the English debate and experience to date.

Smoking Ban in Psychiatric Inpatient Unit: An Iranian Study on the Views and Attitudes of the Mental Health Staff and Psychiatric Patients.

Although the move to smoke-free mental health inpatient settings is an internationally common and popular trend, these policies are neither implemented nor supported by any national program in Iran. This study investigates the attitude of mental health staff and psychiatric patients toward smoking cessation in 2 psychiatric inpatient units (psychosomatic and adult general psychiatry) in the Taleghani general hospital in Tehran. One hundred and twenty participants of this cross-sectional study consist of 30 mental health staff and 90 psychiatric patients. An eight-item questionnaire was used for collecting information. Both staff and patients expressed a positive attitude towards smoking cessation. Patients favoured the implementation of these policies and expressed a more positive attitude towards the feasibility. Sixty-three percent of patients and 57% of staff were opposed to smoking in the units. Seventy percent of patients reported the smoke-free ban as a feasible policy compared to 45% of staff who did the same. The implementation of the smoke-free policy has more support in both staff and patients than the continuation of smoking in psychiatric units. There is a need for an ongoing education and training for mental health care providers, in order to have a successful implementation of smoke-free policy.

Implementing National Institute for Health and Care Excellence smoke-free guidance in a secure facility: an evaluation of the prescribing costs in clozapine users.

Patients (38) who were prescribed clozapine were included in the study. A moderate reduction in dose was noted with a moderate reduction in prescribing costs. The total increase in cost for the whole group, however, was £17 624, largely due to the use of nicotine replacement therapy and an increase in the number of clozapine assay tests. Clinical implications Further studies on implementing this important policy change are needed. The positive effects must be balanced with increased financial pressure on Mental Health Trusts. Declarations of interest None.

Preparing for Completely Smoke-Free Mental Health Settings: Findings on Patient Smoking, Resources Spent Facilitating Smoking Breaks, and the Role of Smoking in Reported Incidents from a Large Mental Health Trust in England.

Introduction: Despite high smoking prevalence and excessive smoking-related morbidity and mortality among people with mental disorder compared to the general population, smoking treatment is often neglected in mental health settings. The UK National Institute of Health and Clinical Excellence (NICE) recently issued public health guidance stipulating completely smoke-free mental health settings. This project evaluated existing smoking-related practices in preparation for guidance implementation. The objectives were to: audit the recording of smoking-related information and treatment provision; explore current arrangements relating to the facilitation of patient smoking; measure staff time spent and identify costs of facilitating smoking; and explore the role of smoking in smoking-related incidents. Methods: A mixed-methods study was conducted across four acute adult mental health wards, accommodating 16 patients each, over six months. It included a case-note audit, on-site observations, and a qualitative content analysis of incident reports. Results: Smoking status was recorded for less than half of the 290 patients admitted (138, 48%). Of those, 98 (71%) were recorded as current smokers, of whom 72 (74%) had received brief smoking cessation advice. Staff spent 6028 h facilitating smoking, representing an annual cost of £131,040 across four wards. Incident reports demonstrated that smoking facilitation was often central to the cause of incidences, triggered frustration in patients, and strained staff resources. Conclusion: The findings highlight the importance and potential of implementing completely smoke-free policies using comprehensive pathways.

Achieving smoke-free mental health services: lessons from the past decade of implementation research.

The culture of smoking by patients and staff within mental health systems of care has a long and entrenched history. Cigarettes have been used as currency between patients and as a patient management tool by staff. These settings have traditionally been exempt from smoke-free policy because of complex held views about the capacity of people with mental disorder to tolerate such policy whilst they are acutely unwell, with stakeholders’ continuing fierce debate about rights, choice and duty of care. This culture has played a significant role in perpetuating physical, social and economic smoking associated impacts experienced by people with mental disorder who receive care within mental health care settings. The past decade has seen a clear policy shift towards smoke-free mental health settings in several countries. While many services have been successful in implementing this change, many issues remain to be resolved for genuine smoke-free policy in mental health settings to be realized. This literature review draws on evidence from the international published research, including national audits of smoke-free policy implementation in mental health units in Australia and England, in order to synthesise what we know works, why it works, and the remaining barriers to smoke-free policy and how appropriate interventions are provided to people with mental disorder.

A protocol for a smoke-free mental health facility

It is not uncommon for staff of mental health facilities to have diverging opinions regarding the tobacco use of their patients. Surveys have shown that a significant proportion of staff believe that the smoke free policies are harsh and difficult to implement in health facilities where patient compliance is a matter of serious concern (Lawn, 2004, Wye et al., 2010). Intra-staff disputes and arguments with patients as to how to implement these policies, if at all, occur frequently. This protocol was developed at the request of staff at a mental health facility for HIV AIDS patients afflicted with dementia. Staff were concerned about imminent smoke-free regulations that would impact on their unit.

Qualitative exploration of family perspectives of smoke‐free mental health and addiction services

The significant health disparities experienced by people with mental illness indicate the need for mental health service improvement. This qualitative study explored family and whānau (Māori family group) perspectives of smoke-free mental health services. Thematic analysis found that family and whānau identified a number of barriers to the implementation of successful smoke-free policy, including lack of coordination and consistency, and limited, if any, family and whānau inclusion. Family and whānau discussed smoking as a strategy for coping with anxiety and boredom; therefore, the need for other activities and strategies to replace smoking was identified as necessary in effective service delivery. The attitude that mental health service policy should be different from general health policy, due to the experience of mental distress, was also identified. In this paper, we argue that the development and implementation of quality mental health services would be strengthened by involving family and whānau in smoke-free initiatives. Furthermore, the provision of relevant information to family, whānau, and service users would help dispel myths and stigma associated with tobacco and mental health.

Evaluation of a smoke‐free forensic hospital: Patients' perspectives on issues and benefits

In 2008, a new high secure forensic mental health inpatient hospital was opened in New South Wales as a smoke-free facility. This study describes the experience of patients and the impact of the smoke-free policy on smoking intentions and practice. The study methods included: (1) four semi-structured focus groups with 21 current patients; (2) patient surveys collected from 45 current patients; and (3) follow-up survey from 15 discharged patients. All methods included questions related to smoking history, experience of moving to and living in the smoke-free environment and smoking intentions or status post discharge. Many focus group participants indicated that they were now off cigarettes for life while some were angry about the policy. Nearly all (80%) patients surveyed smoked prior to admission. Over one-third (39%) of patients were angry at being forced to stop smoking, while 42% wanted to give up when they were admitted. Most (62%) felt they had gained weight since they stopped smoking; however, 75% indicated that living in a smoke-free environment had a positive effect on their health. Over a third (36%) of patients indicated that they intended to smoke when discharged. Post discharge, of the 12 who smoked prior to admission, seven (58%) remained non-smokers at follow up. This study describes promising findings about the experience of patients moving to a smoke-free mental health inpatient facility, including improved health and potential for sustained smoking cessation post discharge.

Smokefree Mental Health Services ‐ A Chance to Improve Health?

Smokefree Mental Health Services ‐ A Chance to Improve Health?