Implementation of a smoke‐free policy in an inpatient psychiatric facility: Patient‐reported adherence, support, and receipt of nicotine‐dependence treatment

Abstract

The implementation of smoke-free policies in inpatient psychiatric facilities, including patient adherence, mental health nursing staff support, and provision of nicotine-dependence treatment to patients, has been reported to be poor. The extent to which the quality of smoke-free policy implementation is associated with patient views of a policy is unknown. We conducted a cross-sectional survey of 181 patients (53.6%, n = 97 smokers; and 46.4%, n = 84 non-smokers) in an Australian inpatient psychiatric facility with a total smoke-free policy. Smokers' adherence to the policy was poor (83.5% smoked). Only half (53.6%) perceived staff to be supportive of the policy. Most smokers used nicotine-replacement therapy (75.3%); although few received optimal nicotine-dependence treatment (19.6%). Overall, 45.9% of patients viewed the smoke-free policy in the unit as positive (29.9% smokers; 64.3% non-smokers). For smokers, adhering to the ban, perceiving staff to be supportive, and reporting that the nicotine-replacement therapy reduced cravings to smoke were associated with a more positive view towards the smoke-free policy. These findings support the importance of patient adherence, mental health nursing staff support, and adequate provision of nicotine-dependence treatment in strengthening smoke-free policy implementation in inpatient psychiatric settings.

Smoking Cessation Care for People with a Mental Illness: Family Carer Expectations of Health and Community Services

“…Despite the existence of guidelines, the literature indicates that smoking cessation care is not routinely provided to smokers with a mental illness in inpatient (Prochaska et al, 2004;Wye et al, 2010a) or community (Anderson et al, 2013;Bartlem et al, 2015;Bartlem et al, 2014) mental health services and smoking cessation supports such as Quitline referral and nicotine replacement therapy are not routinely provided (Anderson et al, 2013;Bartlem et al, 2015;Bartlem et al, 2014). In GP, suboptimal smoking cessation care has been reported to be provided to both general and mental health patients (Holmberg et al, 2014;Lord et al, 2010;McKayBrown et al, 2008).…”

“…All socio-demographic, clinical, and smoking characteristic items were adapted from previous research (Bartlem et al, 2015). Items detailing the perceived mental health effects of smoking, attitudes to smoking bans in specialist mental health services, and expectations of smoking cessation care provision were developed for the current study.…”

“…Further, recent research suggests that smokers with a mental illnesss would find it acceptable to be provided with smoking cessation care by the health and community services they currently utilise for mental health care (Bartlem et al, 2015;Ferron, Brunette, He, McHugo, & Drake, 2011;Stockings et al, 2013). A survey of 558 clients of community mental health services in Australia for example, found the majority reported that it was acceptable to be provided smoking cessation care from such services in the form of assessment (96%), brief advice to quit (86%), and referral (89%) (Bartlem et al, 2015).…”

“…The delivery of smoking cessation care to people with a mental illness is consistently reported to be suboptimal in inpatient facilities (Prochaska, Gill, & Hall, 2004;Stockings et al, 2015;Wye et al, 2010a), community mental health services (Bartlem et al, 2014;Greening, 2005), and by GPs (Lord, Malone, & Mitchell, 2010;McKay-Brown et al, 2008). For example, a survey of 97 smokers in an Australian inpatient psychiatric facility with a smoke-free policy identified that only 36.1% received brief advice to quit smoking and just 19.8% received brief advice and optimal nicotine replacement therapy .…”

Addressing the arguments against implementation of smoke‐free policies in psychiatric facilities

“…However, it has been shown that inpatients often do not receive optimal levels of NRT and that psychiatric nurses do not feel adequately trained to provide NRT effectively (Hollen et al ., ; Ratschen et al ., ; Stockings et al. ; Wye et al . ; Wye et al .…”