(2017) Effect of implementation of a smoke-free policy on physical violence in a psychiatric inpatient setting: an interrupted time series analysis. Lancet Psychiatry, 4 (7). pp. 540-546. ISSN 2215-0374 Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/44243/1/The%20effect%20of%20implementing%20a %20smoke-free%20policy%20on%20physical%20violence%20within%20a%20psychiatric %20inpatient%20settingaccepted_version.pdf
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A major challenge to forensic services is how to motivate patients to change and engage in therapy. The objective of the study was to develop scales that reliably identify and measure factors that are likely to be an obstacle to patients' motivation to change, and engage with and benefit from therapy. Three measures -the Patient Attitude Questionnaire, the Patient Perception Questionnaire, and the Patient Motivation Inventory -were developed and administered to 116 mentally disordered offenders resident at three medium secure units (Denis Hill Unit, Cane Hill Unit, and Trevor Gibbens Unit) and one open forensic ward (Witley 3 Ward) in the south-east of England. Factor analysis of each scale identified three conceptually meaningful and reliable subscales. Significant differences between units were identified on several of the subscales. Only one of the subscales, measuring reluctance to open up, revealed a significant ethnic difference. The findings provide evidence for the validity and utility of the scales as clinical and research tools.
This study is the first to estimate the time and opportunity costs of facilitating smoking across different wards in a mental health setting in the United Kingdom. Health care resources are scarce, including staff time. Every time staff facilitate smoking, clinical time is diverted away from therapeutic activities that contribute to improved patient health. Rather than suggesting any financial savings can be made through the introduction of smoke-free services, we present one metric of the value to mental health service providers of the hours of clinical time that could be released to provide therapeutic care.
Smoke‐free policies in mental health settings are important to protect health but are often impeded by staff concerns that physical violence may increase. We aimed to address the literature gap about the frequency, nature, and management of physical violence in relation to smoking. We compared the antecedents and containment of smoking‐related incidents of physical violence over a two‐year period, (12 months when an indoor‐only smoke‐free policy was in place, followed by 12 months after a new comprehensive smoke‐free policy was introduced) using incident reports completed by staff in a large mental health organization in London, UK. Sixty‐one smoking‐related incidents occurred during the indoor‐only smoke‐free policy period; 32 smoking‐related incidents occurred during the comprehensive smoke‐free policy. We identified four antecedent categories for physical violence: i) patient request to smoke denied by staff; ii) during a supervised smoking break; iii) staff response to a patient breach of the smoke‐free policy iv) asking for, trading or stealing smoking materials. The antecedent pattern changed across the two policy periods, with fewer incidents of denying a patient's request to smoke and a greater number of incidents involving staff responding to breaches occurring after the introduction of the comprehensive smoke‐free policy. The prohibition of smoking breaks removed this source of violence. Timeout and PRN medication were the most common containment interventions. Understanding the context of smoking‐related violence may inform clinical guidelines about its prevention and management.
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