Type of unit and population served matters when implementing a smoke-free policy in mental health settings: Perceptions of unit managers across England

Abstract

in mental health settings: Perceptions of unit managers across England. AbstractBackground: Globally, smoking remains a significant issue for mental health populations. Many mental health trusts in England are facing challenges of implementing the NICE guidance according to which all mental health settings, no matter the type, should be entirely smoke-free and provide comprehensive smoking cessation support. Aim:To determine if unit type and unit manager smoking status influence mental health smokefree policy implementation.Method: This paper reports on the secondary analysis of data from a cross-sectional survey of 147 mental health inpatient settings in England, in 2010. The original study's main aim was to understand unit managers' perceived reasons for success or failure of smoke-free policy.Results: Unit managers (n=131) held a positive stance towards supporting smoke-free policy and most perceived that the policy was successful. Non-smoker unit managers were more likely to adopt complete bans than smoker unit managers; whereas, smoker unit managers more likely than non-smoker unit managers to think that stopping smoking aggravated patients' mental illness. Smoking rates for staff and patients remain high, as perceived by unit managers, regardless of unit type. Proportion of units offering NRT and peer support to patients was significantly higher in locked units compared to semi-locked or residential rehabilitation.Applied strategies significantly vary by type of unit; whereas, unit managers' knowledge, attitude and practices vary by their smoking status.Discussion: There are nuanced differences in how smoke-free policy is enacted which vary by unit type. These variations recognize the differing contexts of care provision in different types of 2 units serving different patient groups. Addressing staff smoking rates, promoting consistency of staff response to patients' smoking, and providing staff education and support continue to be key strategies to successful smoke-free policy.Conclusions: Our results demonstrate the importance of taking into account the type of unit and acuity of patients when enacting smoke-free policy; and addressing staff smoking.

‘The lesser of two evils’: A qualitative study of staff and client experiences and beliefs about addressing tobacco in addiction treatment settings

“…Finally, because of low numbers of participants in each type of treatment setting, differences were not highlighted. Further research is warranted given the different practices and cultural contexts to treatment provision across types of programs, and recent research, which has found variation in mental health treatment settings [25].…”

Integration of health promotion in clinical hospital departments: standards fulfilment, documentation of needs and service delivery

“…In addition to facilitating the implementation process with teaching and training of staff to be able to handle the new activities, also staff and managerial attitudes (27;28) and individual lifestyle are surprisingly important for successful implementation of HP (28). Interestingly, the patients are positive towards new interventions, and especially positive to being offered HP services as an integrated part of patient pathways (29)(30)(31)(32).…”

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

“…Finally, it has been argued that partial smoking bans in conjunction with smoking cessation support should be considered as a harm minimization approach (National Mental Health Consumer and Carer Forum, ). However, partial smoking bans have been shown to create more problems and often result in inconsistent enforcement of the policy (Lawn & Campion, ; Sohal, Huddlestone & Ratschen, ; Zabeen et al ., ). Additionally, comprehensive bans may be associated with improved smoking outcomes for patients relative to partial bans (Stockings et al ., ).…”

“…Allowing patients to smoke during limited periods increases persistence of nicotine withdrawal, undermines recognition of nicotine dependence as substance abuse and perpetuates a culture of smoking which inadvertently implies it is ‘too hard’ to support this population to manage their smoking behaviour (Moss et al ., ; Prochaska, ; Zabeen et al. ).…”