title: Smoke-free policy in acute mental health wards: avoiding the pitfalls.
abstract: OBJECTIVE
  The objective of this work was to explore the practical implications of, and the problems arising from, the implementation of a comprehensive smoke-free policy in acute adult inpatient mental health wards.
  
  
  METHODS
  This is a qualitative study that uses semistructured interviews with a stratified purposive sample of 16 medical and nonmedical staff of two wards in an acute mental health trust in England that had implemented a smoke-free policy in buildings and grounds in March 2007.
  
  
  RESULTS
  The smoke-free policy was viewed ambivalently and was substantially compromised by widespread use of exceptions such as permitting patients to smoke in an outdoor patio and covert indoor smoking. Smoking breaks were described to be a fixation for patients and sometimes disruptive to therapeutic activities. Nicotine dependence and withdrawal were not assessed or supported systematically. Awareness of interactions between smoking and certain antipsychotic medications was anecdotal and did not impact on clinical practice.
  
  
  CONCLUSIONS
  The implementation of smoke-free policies in these acute mental health wards suffered from the provision of regular institutionalized smoking breaks, a lack of sustained investment in staff training and a lack of comprehensive cessation or abstinence support for patients. These issues need to be addressed; otherwise, the implementation of smoke-free policies in mental health settings may result in unintended adverse effects.
authors.affiliation: UK Center for Tobacco Control Studies, University of Nottingham, City Hospital, Nottingham, UK. mcxer2@nottingham.ac.uk
authors.forename: Elena
authors.initials: E
authors.lastname: Ratschen
authors.forename: John
authors.initials: J
authors.lastname: Britton
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Doody
authors.forename: Ann
authors.initials: A
authors.lastname: McNeill
mesh_terms: D000208:Acute Disease; D000328:Adult; D004739:England; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation*; D011567:Psychiatric Department, Hospital; D016540:Smoking Cessation / Q000331:legislation & jurisprudence*; D000074606:Smoking Prevention