• forensic psychiatry;
  • health promotion;
  • inpatient issues;
  • mental health

Accessible summary

  • Only one in five people in the general population smoke tobacco but most patients in secure and forensic mental health wards are smokers. We need to know why this group are more likely to smoke and why they find it difficult to give up. We could then tailor ‘stop smoking’ interventions to meet their specific needs.
  • To find out more we compared patients who smoke in secure wards with staff smokers.
  • Compared with staff patients were more dependent on nicotine, less ready to quit smoking, smoked to relieve stress and boredom, and were less concerned about health consequences of smoking.
  • Reasons given by patients for smoking suggest that more work is needed at a pre-quit smoking intervention stage to increase motivation to quit. Once readiness to quit is increased, interventions should focus on reducing cravings; finding alternative methods for coping with stress and boredom and achieving enjoyment from alternative sources.


People with mental disorder account for a disproportionately large amount of smokers, and the problem is greatest in inpatient settings. ‘Stop smoking’ services should be tailored to the needs of individual patient groups. It is important therefore to investigate factors relevant to different groups in order to inform future quit smoking interventions. We compared 50 patients and 50 staff in a secure mental health hospital on measures of smoking and smoking motives, nicotine dependence, craving, previous cessation attempts, motivation to quit and quit smoking-related self-efficacy. Patients were significantly more dependent on nicotine with higher levels of craving; were more likely to smoke to cope with stress, for something to do when bored, for enjoyment and pleasure; and reported significantly less readiness to quit smoking. Staff were more likely to cite health concerns as reasons for quitting. Future pre-intervention work with inpatients should focus on increasing their readiness to quit smoking. Once motivation is increased, interventions should include advice on reducing cravings, finding alternative methods for coping with stress and boredom and achieving enjoyment and pleasure from alternative sources.