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Int. J. Environ. Res. Public Health 2013, 10(9), 4224-4244; doi:10.3390/ijerph10094224
Review

Achieving Smoke-Free Mental Health Services: Lessons from the Past Decade of Implementation Research

1,†,*  and 2,3,†
1 Department of Psychiatry, Flinders Human Behaviour and Health Research Unit, Flinders University, Room 4T306, Margaret Tobin Centre, Flinders University, GPO Box 2100, Adelaide 5001, Australia 2 South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham PR3 3BX, UK 3 Department of Population Mental Health, University College London, UCL Partners, London WC1E 7HB, UK These authors contributed equally to this work.
* Author to whom correspondence should be addressed.
Received: 27 July 2013 / Revised: 2 September 2013 / Accepted: 3 September 2013 / Published: 10 September 2013
(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)
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Abstract

The culture of smoking by patients and staff within mental health systems of care has a long and entrenched history. Cigarettes have been used as currency between patients and as a patient management tool by staff. These settings have traditionally been exempt from smoke-free policy because of complex held views about the capacity of people with mental disorder to tolerate such policy whilst they are acutely unwell, with stakeholders’ continuing fierce debate about rights, choice and duty of care. This culture has played a significant role in perpetuating physical, social and economic smoking associated impacts experienced by people with mental disorder who receive care within mental health care settings. The past decade has seen a clear policy shift towards smoke-free mental health settings in several countries. While many services have been successful in implementing this change, many issues remain to be resolved for genuine smoke-free policy in mental health settings to be realized. This literature review draws on evidence from the international published research, including national audits of smoke-free policy implementation in mental health units in Australia and England, in order to synthesise what we know works, why it works, and the remaining barriers to smoke-free policy and how appropriate interventions are provided to people with mental disorder.
Keywords: smoke-free policy; mental disorder; mental illness; smoking; smoking culture; mental health services; psychiatric inpatients smoke-free policy; mental disorder; mental illness; smoking; smoking culture; mental health services; psychiatric inpatients
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Lawn, S.; Campion, J. Achieving Smoke-Free Mental Health Services: Lessons from the Past Decade of Implementation Research. Int. J. Environ. Res. Public Health 2013, 10, 4224-4244.

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Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert