Transition to a smoke‐free culture within mental health and drug and alcohol services: A survey of key stakeholders

Abstract

Tobacco smoking is common among people with mental illnesses, and they carry a higher burden of smoking-related illnesses. Despite this, smoke-free policies and systems for supporting cessation have proved difficult to introduce in mental health and drug and alcohol services (MHDAS). This paper examines the barriers to becoming smoke free within New Zealand services. Key informants, including staff, smoke-free coordinators, and cessation specialists were interviewed. Of the 142 invited informants 61 agreed (42%) to participate in a telephone interview, and 56 provided useable data. Organizations had a permissive or transitioning smoking culture, or were smoke free, defined by smoke-free environments, smoke-free-promoting attitudes and behaviours of management and staff, and cessation support. Most organizations were on a continuum between permissive and transitional cultures. Only eight services had a fully smoke-free culture. MHDAS face many challenges in the transition to a smoke-free culture. They are not helped by exemptions in smoke-free policies for mental health services, staff smoking, negative staff attitudes to becoming smoke free, poor knowledge of nicotine dependence, smoking-related harm and comorbidities, and poor knowledge and skills regarding cessation-support options. Health inequalities will continue across both service and socioeconomic divides without a concerted effort to address smoking.

A mixed-method systematic review and meta-analysis of mental health professionals' attitudes toward smoking and smoking cessation among people with mental illnesses

“…All studies included stated clear research questions or objective, and in all but one study (which did not provide the requisite information in the published report 36), data were judged to be sufficient to address the stated research questions or objectives (however, this study provided relevant for the current review and was therefore included here).…”

“…This perception appeared to arise from beliefs that patients would not be interested in quitting smoking 39, 40, 41, 42, that patients would be unable to quit smoking successfully 35, 36, 40 and the view that smoking cessation would be too much for patients to cope with alongside their other issues 36, 39, 41, 42, 43. A minority of studies reported concerns about the negative consequences of quitting smoking, such as concerns about a negative impact on psychiatric symptoms/abstinence 36, 41, the potential effects on medication 36 and a fear that smoking cessation may make patients violent 36.…”

“…A perceived lack of opportunity to provide smoking cessation support was evident 36, 39, 40, 41, 42, 43. This generally arose from a perceived lack of treatment resources either on‐site or to refer patients to off‐site 36, 40, 41, 42 and a lack of guidance for implementing smoking cessation treatment alongside treatment for patients' primary disorders 36, 41, 42, 43.…”

“…This generally arose from a perceived lack of treatment resources either on‐site or to refer patients to off‐site 36, 40, 41, 42 and a lack of guidance for implementing smoking cessation treatment alongside treatment for patients' primary disorders 36, 41, 42, 43. In addition, a lack of staff 36, 41, staff time 36, 39, funding 36, 40 and support from management 36, 41 were identified as further barriers to providing smoking cessation treatment.…”

“…In a number of studies, staff did not appear to feel that they had the capability to treat nicotine dependence effectively 36, 40, 41, 43. This arose both from a lack of knowledge about nicotine dependence and pharmacological treatments 36, 40, 41, 43 and from a perceived need for specialized training in the provision of smoking cessation support to people with mental illnesses and/or drug and alcohol disorders 40, 41, 43.…”