Background
Methods
Study design
Setting and participants
Procedures
Data collection and analyses
Identification and treatment of tobacco dependence
Prescribing of psychotropic medication and nicotine replacement therapies
Smoking-related incidents
Patients’ experience with smokefree policy implementation
Results
Patient characteristics
Characteristics | Pre-implementation (n = 150) | Post-implementation (n = 165) | |
---|---|---|---|
Frequency (%)
| |||
Gender
|
Male
| 83 (55.3) | 81 (49.1) |
Female
| 67 (44.7) | 84 (50.9) | |
Legal status
|
Detained
| 81 (54.0) | 108 (65.6) |
Voluntary
| 69 (46.0) | 57 (34.4) | |
First admission
|
Yes
| 43 (28.7) | 77 (46.7) |
No
| 107 (71.3) | 88 (53.3) | |
Mean (SD)
| |||
Age (years)
| 47.9 (20.9) | 48.2 (19.8) | |
Length of admission (days)
| 23.2 (15.9) | 37.2 (22.8) |
Identification and treatment of tobacco dependence
Recording of patients’ smoking status
Smoking status recorded | Frequency (%) | |
---|---|---|
Pre-PH48 (n = 150)
|
Post-PH48 (n = 165)
| |
Current smoker
| 70 (46.7) | 65 (39.3) |
Former smoker
| 18 (12.0) | 20 (12.1) |
Never smoker
| 23 (15.3) | 23 (13.9) |
Unknown
| 30 (20.0) | 31 (18.8) |
Information refused
| 1 (0.7) | 3 (1.8) |
Unrecorded
| 8 (5.3) | 23 (13.9) |
Characteristics of smokers identified
Prescriptions of nicotine replacement therapies
Psychotropic medication prescribing
Medication | Pre-PH48 | Post-PH48 | ||
---|---|---|---|---|
n = 76
|
Mean dose (SD)
|
n = 40
|
Mean dose (SD)
| |
Amitriptyline
| – | – | 2 | 20.0 mg (0.0) |
Chlorpromazine
| – | – | 2 | 12.0 mg (0.0) |
Clozapine
| 2 | 325.0 mg (106.1) | 4 | 281.2 mg (132.5) |
Diazepam
| 8 | 21.9 mg (32.7) | 4 | 7.6 mg (3.3) |
Duloxetine
| 2 | 120.0 mg (0.0) | 2 | 90.0 mg (0.0) |
Flupentixol
| 2 | 6.0 mg (4.2) | – | – |
Flupentixol Deconate*
| 2 | 260.0 mg (197.9) | – | – |
Haloperidol
| 7 | 11.3 mg (7.2) | 4 | 9.1 mg (5.6) |
Haloperidol Depot*
| 3 | 116.6 mg (28.9) | 3 | 133.3 mg (28.9) |
Lorazepam
| 7 | 1.1 mg (0.47) | 5 | 1.1 mg (0.54) |
Mirtazapine
| 12 | 37.5 mg (10.1) | 9 | 29.4 mg (14.5) |
Olanzapine
| 37 | 10.2 mg (5.6) | 19 | 9.1 mg (4.8) |
Tamazepam
| 1 | 40.0 mg (−) | – | – |
Zuclopentixol
| 5 | 110.0 mg (82.2) | 4 | 54.7 mg (41.8) |
Zuclopentixol Deconate*
| 6 | 1050.0 mg (234.5) | 5 | 1600.0 mg (489.9) |
Smoking related incidents
Quantitative content analysis
Patient experience
Participant characteristics
Thematic framework analysis
“Because it’s illegal here, smoking, on your leave you feel like need to smoke fast, fast, fast, fast [in case] something happens.” (Participant 1: Male, acute ward).
“I only get eight half an hour a day, unescorted [leave]. I usually smoke two when I am out…That’s because of the leave I need to make sure I keep my nicotine levels up. Having the one cigarette now is not enough, I’ve got to have two.” [Participant 4, Male; Rehabilitation ward].
‘I thought it [smokefree policy] is never going to work, but it…, I suppose it’ll have to work, there is no excuses now, is there.’ [Participant 5: Male; Acute ward].
‘It gets easier as time goes along and that, but I’d like to quit fully and that lot, but because of the stress you go through in here, you need something.’ [Participant 6: Female; Acute ward].
“Within 24 hours of me being here, I was advised by the staff, by one member of staff, to ‘find a stash’ for my cigarettes outside… I appreciated him doing it.” [Participant 4: Male, Rehabilitation ward].
‘I stashed the lighter outside because we are not allowed lighters in the building, so I have never, ever smoked in the building, erm, every time I go on leave on me own, I nip to a spot where, which I know and that and I have a 2 cigarettes at a time, and I come back in, erm, that’s it really.’ [Participant 3: Female; Acute ward].
“You’ve only got to walk out at any point in the day and someone is fiddling about in the trees or the bushes for the cigarettes” [Participant 8; Male; Rehabilitation ward].One patient however described a different experience of strong policy enforcement that was perceived as inappropriate:
“Some people have a stick rammed right up their backside where they’re challenging patients. To me that’s not a way to be with people with mental illness…They do that in front of everybody instead of taking them to one side” [Participant 4; Male; Acute ward].
‘I’ve seen at least five cleaners smoking, I’ve seen three staff, one from this ward and a couple from another… I’ve even seen them smoking with patients as well, so they’ve taken somebody for a walk, and they sit and smoke together.’ [Participant 7; Female; Rehabilitation ward].
‘Yeah, well now, I’ve been stopping smoking but I know when I get out I’ll probably smoke a spliff, so I might end up back on cigarettes…’ [Participant 2: Male; Rehabilitation ward].