title: Implementation of smoke-free policies in mental health in-patient settings in England.
abstract: BACKGROUND
  Mental health units in England had to become smoke-free by law from July 2008. Concerns regarding the implementation and enforcement of smoke-free policies in these settings have been raised.
  
  
  OBJECTIVE
  To study difficulties and challenges associated with smoke-free policy implementation in English National Health Service (NHS) mental health settings.
  
  
  METHODS
  Questionnaire survey of all 72 English NHS trusts providing mental health in-patient services and facilities, supplemented by semi-structured telephone interviews at a systematic sample of 7 trusts and site visits at a convenience sample of 5 trusts.
  
  
  RESULTS
  Questionnaires were returned by 79% of the trusts, all of whom had implemented smoke-free policies. Most respondents (91%) believed that mental health settings faced particular challenges, arising from the high smoking prevalence among patients (81%), related safety risks (70%), adverse effects on the clinician-patient relationship (36%), and potential interactions with antipsychotic medication (34%). Interviews indicated that sustained policy enforcement was perceived as difficult, but that despite challenges and concerns, the impact of the policy was regarded as beneficial, with some evidence of positive behavioural changes occurring in people.
  
  
  CONCLUSIONS
  Many mental health trusts across England have implemented comprehensive smoke-free policies but the majority state that they are facing specific difficulties. Challenges and concerns need to be explored in depth and addressed to ensure that smoke-free policies implemented under the terms of the Health Act in July 2008 are not undermined.
authors.affiliation: UK Centre for Tobacco Control Studies, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, 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: Ann
authors.initials: A
authors.lastname: McNeill
mesh_terms: D001291:Attitude of Health Personnel; D004739:England; D005161:Facility Regulation and Control / Q000331:legislation & jurisprudence*; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006778:Hospitals, Psychiatric / Q000458:organization & administration*; D006801:Humans; D016134:Organizational Policy; D012907:Smoking / Q000331:legislation & jurisprudence*; D016540:Smoking Cessation / Q000523:psychology; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires