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Implementation of smoke-free policies in mental health in-patient settings in England

Published online by Cambridge University Press:  02 January 2018

Elena Ratschen ,
John Britton  and
Ann McNeill
Elena Ratschen*
Affiliation:
Centre for Tobacco Control Studies, University of Nottingham, City Hospital, Nottingham, UK
John Britton
Affiliation:
Centre for Tobacco Control Studies, University of Nottingham, City Hospital, Nottingham, UK
Ann McNeill
Affiliation:
Centre for Tobacco Control Studies, University of Nottingham, City Hospital, Nottingham, UK
*
Elena Ratschen, UK Centre for Tobacco Control Studies, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB. Email: [email protected]
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Abstract

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Background

Mental health units in England had to become smoke-free by law from July 2008. Concerns regarding the implementation and enforcement of smoke-free policies in these settings have been raised.

Aims

To study difficulties and challenges associated with smoke-free policy implementation in English National Health Service (NHS) mental health settings.

Method

Questionnaire survey of all 72 English NHS trusts providing mental health in-patient services and facilities, supplemented by semi-structured telephone interviews at a systematic sample of 7 trusts and site visits at a convenience sample of 5 trusts.

Results

Questionnaires were returned by 79% of the trusts, all of whom had implemented smoke-free policies. Most respondents (91%) believed that mental health settings faced particular challenges, arising from the high smoking prevalence among patients (81%), related safety risks (70%), adverse effects on the clinician–patient relationship (36%), and potential interactions with antipsychotic medication (34%). Interviews indicated that sustained policy enforcement was perceived as difficult, but that despite challenges and concerns, the impact of the policy was regarded as beneficial, with some evidence of positive behavioural changes occurring in people.

Conclusions

Many mental health trusts across England have implemented comprehensive smoke-free policies but the majority state that they are facing specific difficulties. Challenges and concerns need to be explored in depth and addressed to ensure that smoke-free policies implemented under the terms of the Health Act in July 2008 are not undermined.

Type
Papers
Information
The British Journal of Psychiatry , Volume 194 , Issue 6 , June 2009 , pp. 547 - 551
Copyright
Copyright © Royal College of Psychiatrists, 2009 

Footnotes

The study was funded by the Division of Epidemiology and Public Health, University of Nottingham, in the context of the Masters of Public Health Course 2006/2007.

Declaration of interest

None.

References

1 Smokefree England. Smokefree England Factsheet. Smokefree Regulations – February 2007 update. NHS, 2007 (http://www.smokefreeengland.co.uk/files/regulations_factsheet_final.pdf).Google Scholar
2 Coulthard, M, Farrell, M, Singleton, N, Meltzer, H. Tobacco, Alcohol and Drug Use and Mental Health. TSO (The Stationery Office), 2000.Google Scholar
3 Meltzer, H. OPCS Surveys of Psychiatric Morbidity in Great Britain, Report 6: Economic Activity and Social Functioning of Residents with Psychiatric Disorders. TSO (The Stationery Office), 1996.Google Scholar
4 Greeman, M, McClellan, TA. Negative effects of a smoking ban on an inpatient psychiatry service. Psychiatr Serv 1991; 42: 408–12.CrossRefGoogle Scholar
5 Alam, F. Exempting mental health units from smoke-free law. BMJ 2007; 333: 551–2.Google Scholar
6 Campion, J, McNeill, A, Checinski, K. Exempting mental health units from smoke-free laws. BMJ 2006; 333: 407–8.CrossRefGoogle ScholarPubMed
7 Julyan, TE. Exempting mental health units from smoke-free law. BMJ 2007; 333: 551.Google Scholar
8 Willemsen, MC, Gorts, CA, Van, SP, Jonkers, R, Hilberink, SR. Exposure to environmental tobacco smoke (ETS) and determinants of support for complete smoking bans in psychiatric settings. Tob Control 2004; 13: 180–5.CrossRefGoogle ScholarPubMed
9 Jochelson, K, Majrowski, B. Clearing the Air. Debating Smoke-Free Policy in Psychiatric Units. King's Fund, 2006 (http://www.kingsfund.org.uk/publications/kings_fund_publications/clearing_the.html).Google Scholar
10 Jochelson, K. Smoke-free legislation and mental health units: the challenges ahead. Br J Psychiatry 2006; 189: 479–80.CrossRefGoogle ScholarPubMed
11 Pritchard, C. Smoke-free: a plea to evaluate (eLetter). Br J Psychiatry 2007; 28 November (http://bjp.rcpsych.org/cgi/eletters/190/1/81-a#9127).Google Scholar
12 McNeill, A, Owen, L. Guidance for Smokefree Hospital Trusts. Health Development Agency, 2005.Google Scholar
13 Ratschen, E, Britton, J, McNeill, A. Smoke-free hospitals – the English experience. Results from a survey, interviews, and site visits. BMC Health Serv Res 2008; 8: 41.CrossRefGoogle ScholarPubMed
14 Lawn, S, Pols, R. Smoking bans in psychiatric inpatient settings? A review of the research. Aust NZ J Psychiatry 2005; 39: 866–85.CrossRefGoogle ScholarPubMed
15 McNeill, A. Smoking and Mental Health – A Review of the Literature. Smokefree London Programme, 2001 (http://www.scan.uk.net/docstore/smoking_and_mental_health_lit_review.pdf).Google Scholar
16 El-Guebaly, N, Cathcart, J, Currie, S, Brown, D, Gloster, S. Public health and therapeutic aspects of smoking bans in mental health and addiction settings. Psychiatr Serv 2002; 53: 1617–22.CrossRefGoogle ScholarPubMed
17 Barker, AF, Moseley, JR, Glidewell, BL. Components of a smoke-free hospital program. Arch Intern Med 1989; 49: 1357–9.Google Scholar
18 Etter, J-F, Khan, N, Etter, M. Acceptability and impact of partial smoking ban, followed by a total smoking ban in a psychiatric hospital. Eur Psychiatry 2007; 22: 153.CrossRefGoogle Scholar
12 McNeill, A, Owen, L. Guidance for Smokefree Hospital Trusts. Health Development Agency, 2005.Google Scholar
13 Ratschen, E, Britton, J, McNeill, A. Smoke-free hospitals – the English experience. Results from a survey, interviews, and site visits. BMC Health Serv Res 2008; 8: 41.CrossRefGoogle ScholarPubMed
14 Lawn, S, Pols, R. Smoking bans in psychiatric inpatient settings? A review of the research. Aust NZ J Psychiatry 2005; 39: 866–85.CrossRefGoogle ScholarPubMed
15 McNeill, A. Smoking and Mental Health – A Review of the Literature. Smokefree London Programme, 2001 (http://www.scan.uk.net/docstore/smoking_and_mental_health_lit_review.pdf).Google Scholar
16 El-Guebaly, N, Cathcart, J, Currie, S, Brown, D, Gloster, S. Public health and therapeutic aspects of smoking bans in mental health and addiction settings. Psychiatr Serv 2002; 53: 1617–22.CrossRefGoogle ScholarPubMed
17 Barker, AF, Moseley, JR, Glidewell, BL. Components of a smoke-free hospital program. Arch Intern Med 1989; 49: 1357–9.Google Scholar
18 Etter, J-F, Khan, N, Etter, M. Acceptability and impact of partial smoking ban, followed by a total smoking ban in a psychiatric hospital. Eur Psychiatry 2007; 22: 153.CrossRefGoogle Scholar
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