published in the June issue of the British Journal
, shows most mental health settings in England
have faced challenges in introducing smoke-free policies.
However, the results also suggest that the
policies can bring about positive changes, including behavioural
changes in patients.
Researchers at the University of Nottingham’s
Centre for Tobacco Control Studies surveyed all 72 English NHS
trusts providing mental health in-patient services. In addition,
telephone interviews were conducted with 7 trusts and site visits
made to a further 5 trust.
According to the survey responses, most trusts
(91%) believed that mental health settings faced ‘particular
challenges’ in implementing smoke-free policies when compared to
other settings. These included the high prevalence of smoking among
service users, safety risks, and potential interactions with
antipsychotic medication. But despite these challenges,
almost all the trusts (92%) surveyed believed going smoke-free had
been quite or very successful. Fears of an increase in aggressive
or violent incidents among patients have also proved largely
The in-depth telephone and face-to-face
interviews conducted with trusts revealed a number of positive
effects. Writing in the British Journal of Psychiatry, the
study authors said: “One respondent reported that patients were
sleeping better as a result of closing smoking rooms at social
gathering points where the consumption of nicotine and often
caffeine had been frequent and heavy both during the days and
“Another said that patients were reported to
get up and out of their rooms earlier in the mornings, since they
were no longer allowed to smoke indoors. Three respondents reported
that individuals specifically welcomed the use of newly-created
recreational spaces that had been provided in former smoking rooms,
and that this was having a positive impact on their behaviour and
sense of well-being.”
The researchers observed that “considerable
efforts” have been made to implement smoke-free policies in mental
health in-patient units, and overall the outcome has been positive.
However, they concluded: “Challenges are widely perceived.
These need to be explored further and addressed adequately to
support trusts in complying with the Health Act and maximising the
benefit of the law.”