There’s no smoke without fire: Smoking in smoke-free acute mental health wards

<h4>Background</h4> People who smoke with serious mental illness carry disproportionate costs from smoking, including poor health and premature death from tobacco-related illnesses. Hospitals in New Zealand are ostensibly smoke-free; however, some mental health wards have resisted implem...

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Autores principales:	Gabrielle Jenkin, Jacqueline McIntosh, Janet Hoek, Krishtika Mala, Hannah Paap, Debbie Peterson, Bruno Marques, Susanna Every-Palmer
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/0604fe2fbd5643f7be2419f4ae82971c
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spelling	oai:doaj.org-article:0604fe2fbd5643f7be2419f4ae82971c2021-11-25T05:54:25ZThere’s no smoke without fire: Smoking in smoke-free acute mental health wards1932-6203https://doaj.org/article/0604fe2fbd5643f7be2419f4ae82971c2021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8592473/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4> People who smoke with serious mental illness carry disproportionate costs from smoking, including poor health and premature death from tobacco-related illnesses. Hospitals in New Zealand are ostensibly smoke-free; however, some mental health wards have resisted implementing this policy. <h4>Aim</h4> This study explored smoking in acute metal health wards using data emerging from a large sociological study on modern acute psychiatric units. <h4>Methods</h4> Eighty-five in-depth, semi-structured interviews were conducted with staff and service users from four units. Data were analysed using a social constructionist problem representation approach. <h4>Results</h4> Although high-level smoke-free policies were mandatory, most participants disregarded these policies and smoking occurred in internal courtyards. Staff reasoned that acute admissions were not the time to quit smoking, citing the sceptres of distress and possibly violence; further, they found smoking challenging to combat. Inconsistent enforcement of smoke-free policies was common and problematic. Many service users also rejected smoke-free policies; they considered smoking facilitated social connections, alleviated boredom, and helped them feel calm in a distressing environment – some started or increased smoking following admission. A minority viewed smoking as a problem; a fire hazard, or pollutant. No one mentioned its health risks. <h4>Conclusion</h4> Psychiatric wards remain overlooked corners where hospital smoke-free policies are inconsistently applied or ignored. Well-meaning staff hold strong but anachronistic views about smoking. To neglect smoking cessation support for people with serious mental illness is discriminatory and perpetuates health and socioeconomic inequities. However, blanket applications of generic policy are unlikely to succeed. Solutions may include myth-busting education for service users and staff, local champions, and strong managerial support and leadership, with additional resourcing during transition phases. Smoke-free policies need consistent application with non-judgemental NRT and, potentially, other treatments. Smoking cessation would be supported by better designed facilities with more options for alleviating boredom, expressing autonomy, facilitating social connections, and reducing distress.Gabrielle JenkinJacqueline McIntoshJanet HoekKrishtika MalaHannah PaapDebbie PetersonBruno MarquesSusanna Every-PalmerPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Gabrielle Jenkin Jacqueline McIntosh Janet Hoek Krishtika Mala Hannah Paap Debbie Peterson Bruno Marques Susanna Every-Palmer There’s no smoke without fire: Smoking in smoke-free acute mental health wards
description	<h4>Background</h4> People who smoke with serious mental illness carry disproportionate costs from smoking, including poor health and premature death from tobacco-related illnesses. Hospitals in New Zealand are ostensibly smoke-free; however, some mental health wards have resisted implementing this policy. <h4>Aim</h4> This study explored smoking in acute metal health wards using data emerging from a large sociological study on modern acute psychiatric units. <h4>Methods</h4> Eighty-five in-depth, semi-structured interviews were conducted with staff and service users from four units. Data were analysed using a social constructionist problem representation approach. <h4>Results</h4> Although high-level smoke-free policies were mandatory, most participants disregarded these policies and smoking occurred in internal courtyards. Staff reasoned that acute admissions were not the time to quit smoking, citing the sceptres of distress and possibly violence; further, they found smoking challenging to combat. Inconsistent enforcement of smoke-free policies was common and problematic. Many service users also rejected smoke-free policies; they considered smoking facilitated social connections, alleviated boredom, and helped them feel calm in a distressing environment – some started or increased smoking following admission. A minority viewed smoking as a problem; a fire hazard, or pollutant. No one mentioned its health risks. <h4>Conclusion</h4> Psychiatric wards remain overlooked corners where hospital smoke-free policies are inconsistently applied or ignored. Well-meaning staff hold strong but anachronistic views about smoking. To neglect smoking cessation support for people with serious mental illness is discriminatory and perpetuates health and socioeconomic inequities. However, blanket applications of generic policy are unlikely to succeed. Solutions may include myth-busting education for service users and staff, local champions, and strong managerial support and leadership, with additional resourcing during transition phases. Smoke-free policies need consistent application with non-judgemental NRT and, potentially, other treatments. Smoking cessation would be supported by better designed facilities with more options for alleviating boredom, expressing autonomy, facilitating social connections, and reducing distress.
format	article
author	Gabrielle Jenkin Jacqueline McIntosh Janet Hoek Krishtika Mala Hannah Paap Debbie Peterson Bruno Marques Susanna Every-Palmer
author_facet	Gabrielle Jenkin Jacqueline McIntosh Janet Hoek Krishtika Mala Hannah Paap Debbie Peterson Bruno Marques Susanna Every-Palmer
author_sort	Gabrielle Jenkin
title	There’s no smoke without fire: Smoking in smoke-free acute mental health wards
title_short	There’s no smoke without fire: Smoking in smoke-free acute mental health wards
title_full	There’s no smoke without fire: Smoking in smoke-free acute mental health wards
title_fullStr	There’s no smoke without fire: Smoking in smoke-free acute mental health wards
title_full_unstemmed	There’s no smoke without fire: Smoking in smoke-free acute mental health wards
title_sort	there’s no smoke without fire: smoking in smoke-free acute mental health wards
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/0604fe2fbd5643f7be2419f4ae82971c
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There’s no smoke without fire: Smoking in smoke-free acute mental health wards

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