New research published in the June issue of the British Journal of Psychiatry, 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 unfounded.

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 evenings.

"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."

Reference:
"Implementation of smoke-free policies in mental health in-patient settings in England"
Ratschen E, Britton J and McNeill A (2009)
British Journal of Psychiatry, 194: 547-551

Source
Royal College of Psychiatrists