Attitudes towards non-smoking policies among in-patients in
psychiatric units differ considerably from those of the general
population, raising the question whether some compromise should be
introduced when mental health trusts are required to adopt the
policy later this year.
Whilst 89.6% of the public believe that smoking should be banned
in public places, only 54.1% of psychiatric in-patients agree with
the idea. 71.1% of in-patients support a general non-smoking policy
in hospital with designated smoking areas.
On 1st July 2007 all enclosed or substantially enclosed public
places and work places became smoke free, as required by The Health
Act 2006. A temporary exemption for mental health units ends on 1st
July 2008. Until then, they may have a designated smoking room
meeting specified requirements.
A survey at Mersey Care NHS Trust (a mental health trust) was
published in the May 2008 issue of the Psychiatric Bulletin. It set
out to explore the attitudes of in-patients across the General
Adult and Old Age Directorates of the Trust towards hospital and
government smoking policies, and towards the perceived effects of
smoking on health and well-being.
At the time of the survey, the Trust had a general non-smoking
policy that entailed one or two smoking rooms on each ward, with
all other enclosed areas being non-smoking.
Out of 243 in-patients on the 13 wards, 135 were successfully
interviewed. It was found that 54.1% of participants smoked.
Significantly more of those aged under 65 smoked (63.1%) than those
aged 65 and over (25.0%). Within the smoking group, 59.7% smoked at
least 20 cigarettes a day.
92.6% of participants believed that smoking was harmful to
health, with smokers less likely to believe this than non-smokers
(86% v. 100%). As many as 84.4% of participants thought passive
smoking was harmful to health, with no difference between smokers
and non-smokers.
42.2% reported difficulties with the current general non-smoking
policy. Only 3% supported the idea of a complete ban inside and on
hospital premises, though 14.1% thought there should be a complete
ban inside only.
71.1% supported a general non-smoking policy with designated
smoking areas, and 54.1% agreed with government proposals to make
all public places non-smoking. Non-smokers were more likely to
agree than smokers (77% v. 34%).
More smokers reported a decrease in smoking after entering
hospital (23%) than an increase (14.1%), challenging the assumption
that it would be particularly difficult to target non-smoking
policies at psychiatric in-patients.
Although non-smokers and smokers were equally likely to have
problems with the existing policy, the majority of complaints
(80.8%) were anti-smoking in nature. Nevertheless, despite these
difficulties and knowledge of the harmful effects of smoking, the
hospital’s current general non-smoking policy was by far the most
popular (71.1%).
The fact that this study showed a large difference between those
wanting a total smoking ban inside hospital buildings (14.1%) and
those supporting the government ban on smoking in public places
(54.1%) may reflect views that smoking policy should be more
lenient in psychiatric units.
The figure of 54.1% is also considerably lower than was seen in
the public consultation on the Health Bill, where 89.6% supported a
ban on smoking in public places.
This study reinforces previous findings that smoking is more
prevalent among psychiatric patients than in the general
population. As the majority of in-patients, both smokers and
non-smokers, felt that there should be smoking areas within
psychiatric units, can any appropriate compromise be reached in
view of the current legislation, ask the researchers?
It would be interesting to know, they say, whether these results
are mirrored elsewhere in the country, and whether patients’ views
are changing following implementation of tighter smoking policies
within NHS trusts. It would also be worth evaluating the level of
compliance with such policies.