Evaluation of a totally smoke-free forensic psychiatry inpatient facility: practice and policy implications

Abstract

Objective: To evaluate the impact of implementing smoke-free policy in an Australian high security forensic psychiatry inpatient hospital. Methods: Focus groups (N=21) and surveys with patients (N=45) and surveys with staff (N=111, 53.2% nurses) elicited their experience and attitudes towards smoke-free policy. A follow-up survey elicited the impact of the policy on 15 patients’ smoking practice post discharge. Results: Eighty-five percent of patients stated it was easier quitting when no-one else smoked. Over half of discharged patients surveyed (58%) continued to not smoke post-discharge, despite almost half of staff (41%) perceiving that patients were unlikely to quit long-term. Smoking staff were significantly more pessimistic than non-smoking staff. Many patients (69%) perceived that their health had improved as a result of not smoking. Most staff (80%) viewed nicotine dependence treatment as important, but fewer (66%) felt confident to support patients to stop smoking. Increased patient violence and management difficulties expected by staff were not realized. Conclusions: Smoke-free policy can be successfully implemented in forensic psychiatry inpatient units. Nursing staff are a large and important group who need particular support to implement smoke-free policy into practice effectively, particularly those who are smokers. Continuity of care as part of a coordinated policy and service response is needed.