Should Non-smoking Policy For Psychiatric In-patients Be More Lenient?

Main Category: Smoking / Quit Smoking
Also Included In: Psychology / Psychiatry;  Alcohol / Addiction / Illegal Drugs
Article Date: 05 May 2008 - 3:00 PDT

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Attitudes towards non-smoking policies among in-patients in psychiatric units differ considerably from those of the general population, raising the question whether some compromise should be introduced when mental health trusts are required to adopt the policy later this year.

Whilst 89.6% of the public believe that smoking should be banned in public places, only 54.1% of psychiatric in-patients agree with the idea. 71.1% of in-patients support a general non-smoking policy in hospital with designated smoking areas.

On 1st July 2007 all enclosed or substantially enclosed public places and work places became smoke free, as required by The Health Act 2006. A temporary exemption for mental health units ends on 1st July 2008. Until then, they may have a designated smoking room meeting specified requirements.

A survey at Mersey Care NHS Trust (a mental health trust) was published in the May 2008 issue of the Psychiatric Bulletin. It set out to explore the attitudes of in-patients across the General Adult and Old Age Directorates of the Trust towards hospital and government smoking policies, and towards the perceived effects of smoking on health and well-being.

At the time of the survey, the Trust had a general non-smoking policy that entailed one or two smoking rooms on each ward, with all other enclosed areas being non-smoking.

Out of 243 in-patients on the 13 wards, 135 were successfully interviewed. It was found that 54.1% of participants smoked. Significantly more of those aged under 65 smoked (63.1%) than those aged 65 and over (25.0%). Within the smoking group, 59.7% smoked at least 20 cigarettes a day.

92.6% of participants believed that smoking was harmful to health, with smokers less likely to believe this than non-smokers (86% v. 100%). As many as 84.4% of participants thought passive smoking was harmful to health, with no difference between smokers and non-smokers.

42.2% reported difficulties with the current general non-smoking policy. Only 3% supported the idea of a complete ban inside and on hospital premises, though 14.1% thought there should be a complete ban inside only.

71.1% supported a general non-smoking policy with designated smoking areas, and 54.1% agreed with government proposals to make all public places non-smoking. Non-smokers were more likely to agree than smokers (77% v. 34%).

More smokers reported a decrease in smoking after entering hospital (23%) than an increase (14.1%), challenging the assumption that it would be particularly difficult to target non-smoking policies at psychiatric in-patients.

Although non-smokers and smokers were equally likely to have problems with the existing policy, the majority of complaints (80.8%) were anti-smoking in nature. Nevertheless, despite these difficulties and knowledge of the harmful effects of smoking, the hospital's current general non-smoking policy was by far the most popular (71.1%).

The fact that this study showed a large difference between those wanting a total smoking ban inside hospital buildings (14.1%) and those supporting the government ban on smoking in public places (54.1%) may reflect views that smoking policy should be more lenient in psychiatric units.

The figure of 54.1% is also considerably lower than was seen in the public consultation on the Health Bill, where 89.6% supported a ban on smoking in public places.

This study reinforces previous findings that smoking is more prevalent among psychiatric patients than in the general population. As the majority of in-patients, both smokers and non-smokers, felt that there should be smoking areas within psychiatric units, can any appropriate compromise be reached in view of the current legislation, ask the researchers?

It would be interesting to know, they say, whether these results are mirrored elsewhere in the country, and whether patients' views are changing following implementation of tighter smoking policies within NHS trusts. It would also be worth evaluating the level of compliance with such policies.

"Exploration of in-patient attitudes towards smoking within a large mental health trust."
Smith J and O'Callaghan C (2008)
Psychiatric Bulletin 32, 5, pages 166-169.
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The Royal College of Psychiatrists

The Royal College of Psychiatrists is the professional and educational body for psychiatrists in the United Kingdom and the Republic of Ireland. We promote mental health by:

-- Setting standards and promoting excellence in mental health care
-- Improving understanding through research and education
-- Leading, representing, training and supporting psychiatrists
-- Working with patients, carers and their organisations

As well as running its membership examination (MRCPsych), and visiting and approving hospitals for training purposes, the College organises scientific and clinical conferences and lectures and continuing professional development activities. The College publishes books, reports and educational material for professionals and the general public. It also publishes the British Journal of Psychiatry, Psychiatric Bulletin and Advances in Psychiatric Treatment, all of which are now available on-line.

The Royal College of Psychiatrists has been in existence in some form since 1841. First as the "Association of Medical Officers of Asylums and Hospitals for the Insane" (later changed to the Medico Psychological Association) then, in 1926 receiving its Royal Charter to become the "Royal Medico Psychological Association, and finally, in 1971 receiving a Supplemental Charter to become the "Royal College of Psychiatrists" we know today.

www.rcpsych.ac.uk

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