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Smoking bans in psychiatric inpatient settings? A review of the research

Authors

  • Sharon Lawn,

  • Rene Pols


  • Division of Mental Health/Flinders Medical Centre, 820 Marion Road, Marion, South Australia 5043, Australia. Email: sharon.lawn@fmc.sa.gov.au

  • Rene Pols, Senior Consultant Psychiatrist (Division of Mental Health); Senior Lecturer (Department of Psychiatry)

  • Division of Mental Health/Flinders Medical Centre, and Department of Psychiatry, School of Medicine, Flinders University of South Australia, Adelaide, Australia

Sharon Lawn, Senior Social Worker (Correspondence)

Abstract

Objective: This paper reviews the findings from 26 international studies that report on the effectiveness of smoking bans in inpatient psychiatric settings. The main aim is to identify which processes contribute to successful implementation of smoking bans and which processes create problems for implementation in these settings.

Method: After performing an electronic search of the literature, the studies were compared for methods used, subjects involved, type of setting, type of ban, measures and processes used and overall results. Total bans were distinguished from partial bans. All known studies of smoking bans in psychiatric inpatient units from 1988 to the present were included.

Results: Staff generally anticipated more smoking-related problems than actually occurred. There was no increase in aggression, use of seclusion, discharge against medical advice or increased use of as-needed medication following the ban. Consistency, coordination and full administrative support for the ban were seen as essential to success, with problems occurring where this was not the case. Nicotine replacement therapy was widely used by patients as part of coping with bans. However, many patients continued to smoke post-admission indicating that bans were not necessarily effective in assisting people to quit in the longer term.

Conclusions: The introduction of smoking bans in psychiatric inpatient settings is possible but would need to be a clearly and carefully planned process involving all parties affected by the bans. Imposing bans in inpatient settings is seen as only part of a much larger strategy needed to overcome the high rates of smoking among mental health populations.

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