Achieving Smoke-Free Mental Health Services: Lessons from the Past Decade of Implementation Research
Abstract
:1. Introduction
2. Experimental Section
- The term “mental disorder” is used in preference to “mental illness”. It covers the following recognised diagnoses: depression and anxiety (which may also be referred to as “common mental disorder”); schizophrenia and bipolar disorder (which may also be referred to as “severe mental disorder”); and also personality disorder, alcohol use disorder and drug use disorder.
- “Smoke-free” facilities are understood to be those which have an explicit policy banning the consumption of tobacco within the administrative boundaries of the institution in which the facilities are located. However, the literature is inconsistent. This is because many of the older studies from the 1990s and some of the more recent studies from some countries only recently implementing smoke-free policy, for example, talk about smoke-free policy and mean smoking banned from inside inpatient units and within a certain distance from entrances or windows. Some of the more recent literature is also not explicit, so we are not certain about what is meant. Many units are reported to be smoke-free and yet have dedicated areas within hospital grounds or attached to inpatient units (such as adjoined courtyards). Patients and staff in these settings can go there to smoke, either at their leisure of at dedicated times, dependent on local policy variations. Therefore, when we refer to units with “total” smoke-free policies, we mean units where there is no smoking allowed by patients or staff at any time anywhere inside or in the grounds of psychiatric institution [26]. The literature is consistent in stating that, despite a smoke-free hospital policy being in place, this does not preclude those patients and staff who are able to leave the hospital grounds from doing so in order to smoke.
- The term “partial bans” has been used inconsistently also within the literature. In most papers, it means a policy whereby staff can use their discretion to facilitate smoking by some patients. This discretion is usually based on perceived level of agitation and need, while maintaining a general smoke-free stance towards other patients. In other papers, it means a general smoke-free policy but with designated areas within the hospital grounds where people can go to smoke and/or times when smoking is permitted [26].
- Terms such as “compliance” and “enforcement” have also been used ambiguously. This has therefore confused the debates, especially when determining or arguing whether a smoke-free policy has succeeded or failed. We argue that smoke-free policy is a process, not an event. Therefore, compliance does not mean 100% compliance all the time and in all cases. Likewise, enforcement is something that staff need to develop confidence and skill in performing, over time. They will not enforce smoke-free policy effectively in 100% of situations. We argue that success comes with striving towards a smoke-free goal, as this more accurately reflects the reality of implementation processes. This inconsistency in the use of terms across and within different countries and settings needs to be addressed for research and practice change in this area to progress.
3. Results and Discussion
3.1. Smoke-Free Mental Health Settings and Environmental Tobacco Smoke
3.2. Partial and Total Smoke-Free Policy
3.4. Clinical Management of Addiction and Mental Disorder
3.5. Mental Health Patients and Quitting
3.6. Exposure to Other Smokers, off-Site Safety Concerns and Boredom
3.7. Rights and Choice
3.8. Can Smoke-Free Policy Have Positive Impacts?
- clinical and recovery-focused care is enhanced [15,21,22,23,24,29,60,77,91,93]. Jochelson [93] found that patients were less bored and more engaged in ward activities when there was a smoke-free policy. This has been commonly reported in evaluations of smoke-free policy in drug and alcohol settings. In these settings, staff have noted significant reductions in “drug talk” post implementation and greater patient engagement in therapy programs also. Research also suggests that a smoking culture deskills staff [94] and that the imposition of smoke-free policies increase staff skillsets [23,24,71]. Lawn and Condon [94] described the dilemmas psychiatric nurses face when there are no smoking restrictions. This is not due to “lazy nursing”, but rather a demonstration of the unique ethical struggles nurses face when the culture of smoking overwhelms their attempts to provide good clinical
3.9. What Barriers to Smoke-Free Policy Implementation Remain to be Addressed?
3.10. What Makes Smoke-Free Policy Implementation Successful?
3.11. Limitations
4. Conclusions
Acknowledgments
Conflicts of Interest
References
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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. https://doi.org/10.3390/ijerph10094224
Lawn S, Campion J. Achieving Smoke-Free Mental Health Services: Lessons from the Past Decade of Implementation Research. International Journal of Environmental Research and Public Health. 2013; 10(9):4224-4244. https://doi.org/10.3390/ijerph10094224
Chicago/Turabian StyleLawn, Sharon, and Jonathan Campion. 2013. "Achieving Smoke-Free Mental Health Services: Lessons from the Past Decade of Implementation Research" International Journal of Environmental Research and Public Health 10, no. 9: 4224-4244. https://doi.org/10.3390/ijerph10094224