Background People with mental health (MH) disorders smoke at higher rates, are more nicotine-dependent and suffer greater morbidity and mortality from smoking-related illnesses than the general population. Helping these people to quit smoking is a public health priority; however, many MH professionals assume that those with mental illness are not motivated to quit.

Objectives  To use predetermined criteria to identify, review critically and evaluate empirically all English language, peer-reviewed data on motivation to quit smoking in MH populations.

Methods  A systematic search was conducted and key data on subject characteristics, measures of motivation and other variables abstracted. χ2 analyses were used to compare motivation between MH and general populations, between in-patients and out-patients and between people with depression and people with psychotic disorders.

Results  Evidence suggests that people with MH disorders are as motivated to quit smoking as the general population, although those with psychotic disorders may be less motivated than individuals with depression. Although readiness to cease smoking was assessed in 14 studies, only two evaluated motivation to quit smoking in in-patient populations.

Conclusions  People with MH disorders are motivated to quit smoking, although more research is needed looking at in-patient populations. The commonly held false belief that people with MH disorders are not motivated to cease smoking means that opportunities to encourage smoking cessation among this disenfranchised group are being missed.

Assessing motivation to quit smoking in people with mental illness: a review

Smoking bans or restrictions can assist in eliminating nonsmokers' exposure to the dangers of secondhand smoke and can reduce tobacco consumption amongst smokers themselves. Evidence exists identifying the impact of tobacco control regulations and interventions implemented in general workplaces and at an individual level. However, it is important that we also review the evidence for smoking bans at a meso- or organisational level, to identify their impact on reducing the burden of exposure to tobacco smoke. Our review assesses evidence for meso- or organisational-level tobacco control bans or policies in a number of specialist settings, including public healthcare facilities, higher education and correctional facilities.

Impact of institutional smoking bans on reducing harms and secondhand smoke exposure

http://www.stop-tabac.ch/fr/images/stories/documents_stop_tabac/ban_psy_hospital.pdf

Acceptability and impact of a partial smoking ban followed by a total smoking ban in a psychiatric hospital.

Tobacco dependence is the leading cause of death in persons with psychiatric and substance use disorders. This has lead to interest in the development of pharmacological and behavioral treatments for tobacco dependence in this subset of smokers. However, there has been little attention paid to the development of tobacco-free environments in psychiatric institutions despite the creation of smoke-free psychiatric hospitals mandated by the Joint Commission for Accreditation of Health Organizations (JCAHO) in 1992. This review article addresses the reasons why tobacco should be excluded from psychiatric and addictions treatment settings, and strategies that can be employed to initiate and maintain tobacco-free psychiatric settings. Finally, questions for further research in this field are delineated. This Tobacco Reconceptualization in Psychiatry is long overdue, given the clear and compelling benefits of tobacco-free environments in psychiatric institutions.

/pdf/a-tobacco-reconceptualization-in-psychiatry-toward-the-3y5yjgfnqe.pdf

A tobacco reconceptualization in psychiatry: toward the development of tobacco-free psychiatric facilities.

Objective: Tobacco smoking is the leading preventable cause of death and disease in Australia. Even though smoking prevalence in the general population has been reduced (20% smoke), prevalence rates remain high among psychiatric inpatients (70%–90%). This study aimed to identify smoking policies and procedures in public psychiatric inpatient units in New South Wales, Australia; the provision of “smoking care” in such units (for example, quit-smoking advice or nicotine replacement therapy); and policies and procedures associated with the assessment of smoking status and provision of smoking care. Methods: A cross-sectional survey was mailed to all public psychiatric inpatient units in New South Wales for completion by nurse unit managers. Results: Of the 131 units, 123 units completed and returned surveys (94%). Over one-third (36%) of respondents reported instances in which inpatients began smoking during their admission. A similar proportion (39%) reported that staff provided cigarettes to patients who smoked when patients’ supply was expended. Fifty percent of respondents reported that all patients were assessed for smoking status; however, 70% reported that nicotine dependence was not assessed. Units on which staff adhered to smoking restrictions were three times as likely to assess patients’ smoking status as units where staff never adhered to restrictions (odds ratio=3.05, p=.01). Conclusions: Inadequate establishment of nonsmoking environments and of smoking restriction enforcement as well as inconsistencies in the provision of smoking care were evident. The findings suggest that failure of psychiatric services to provide smoking care is systemic and not related to particular types of services (for example acute versus nonacute or regional versus metropolitan). (Psychiatric Services 60:100–107, 2009)

https://ps.psychiatryonline.org/doi/pdfplus/10.1176/ps.2009.60.1.100

Smoking restrictions and treatment for smoking: policies and procedures in psychiatric inpatient units in Australia

In contrast to general medical hospitals, psychiatric hospitals often allow patients to smoke cigarettes. In addition to obvious health concerns, smoking can also interfere with clinical assessments and therapeutic activities, Implementation of a smoking ban on an acute male admissions unit did not result in any increase in aggressive behaviors. In addition, staff attitudes following the ban improved, and most staff members believed the ban was both ethical and beneficial to patients. Our research indicates that banning smoking on an acute admissions unit is feasible and well tolerated by patients and staff, although it may require extra vigilance for smoking-related contraband.

Beth Diaz

Papers

Implementing a smoking ban in an acute psychiatric admissions unit.