title: Tobacco dependence, treatment and smoke-free policies: a survey of mental health professionals' knowledge and attitudes.
abstract: BACKGROUND
  Mental health inpatient units in England have to be smoke-free by law. Preliminary studies have indicated that staff may not have the necessary knowledge and resources to support the implementation of a smoke-free policy.
  
  
  OBJECTIVE
  The objective of this study was to investigate staff knowledge and attitudes relating to smoking prevalence, dependence, treatment and the relationship between smoking and mental illness.
  
  
  METHODS
  This study used a questionnaire survey for all the clinical staff of 25 inpatient mental health units of a UK National Health Service mental health Trust.
  
  
  RESULTS
  Four hundred fifty-nine (68%) staff returned the questionnaire. Less than half (42%) of the participants agreed that dealing with patients' smoking was their responsibility as a mental health professional, and only half (50%) asserted that they could make time to treat smoking in their working routine. All professional groups demonstrated a lack of knowledge about tobacco dependence, treatment and its relation with mental illness, with healthcare assistants being least knowledgeable overall. Nevertheless, 41% of doctors were unaware that smoking can decrease blood levels of antipsychotic medications, and 36% were unaware that stopping smoking could reduce the dose needed. Staff overestimated the prevalence of smoking in the general population, and over a third (36.4%) believed that nicotine was carcinogenic. Staff smoking prevalence was 26% (10% of doctors, 22% of other qualified staff and 37% of nonqualified staff), and smokers were more likely to have reservations about the importance of the smoke-free policy and the treatment of nicotine dependence among patients. Reported participation in training was associated with greater knowledge related to some items of the questionnaire.
  
  
  CONCLUSIONS
  Support for inpatient smokers by staff is likely to be severely compromised by low levels of knowledge and awareness of tobacco dependence. Further training and support for all staff groups are urgently required.
authors.affiliation: Clinical Sciences Building, University of Nottingham, City Hospital, NG5 1PB 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: Jo
authors.initials: J
authors.lastname: Leonardi-Bee
authors.forename: Ann
authors.initials: A
authors.lastname: McNeill
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003625:Data Collection; D004347:Drug Interactions; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007318:Inservice Training; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D008875:Middle Aged; D016134:Organizational Policy; D010348:Patient Care Team / Q000706:statistics & numerical data*; D011567:Psychiatric Department, Hospital / Q000331:legislation & jurisprudence*; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology / Q000523:psychology*; D016540:Smoking Cessation / Q000331:legislation & jurisprudence* / Q000523:psychology; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000331:legislation & jurisprudence* / Q000517:prevention & control*; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation*
chemical_list: D011619:Psychotropic Drugs; D014028:Tobacco Smoke Pollution