title: Evaluation of a totally smoke-free forensic psychiatry in-patient facility: practice and policy implications.
abstract: OBJECTIVE
  To evaluate the impact of implementing a smoke-free policy in an Australian high-security forensic psychiatry in-patient hospital.
  
  
  METHODS
  Focus groups (n=21) and surveys with both patients (n=45) and staff (n=111; 53.2% nurses) elicited participants' experience of and attitudes towards an introduced smoke-free policy. A follow-up survey elicited the impact of the policy on 15 patients' smoking practice after discharge.
  
  
  RESULTS
  Eighty-five per cent of patients stated it was easier to quit smoking when no one else smoked. Over half the discharged patients surveyed (58%) continued to not smoke after discharge, despite almost half the 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 realised.
  
  
  CONCLUSIONS
  A smoke-free policy can be successfully implemented in forensic psychiatry in-patient units. Nursing staff are a large and important group who need particular support to implement a 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.
authors.affiliation: Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Lawn
authors.affiliation: Justice Health and Forensic Mental Health Network, Suite 302, Level 2, 152 Bunnerong Rd, Eastgardens, NSW 2036, Australia. Email: ; ; ; ;
authors.forename: Angela
authors.initials: A
authors.lastname: Hehir
authors.affiliation: Justice Health and Forensic Mental Health Network, Suite 302, Level 2, 152 Bunnerong Rd, Eastgardens, NSW 2036, Australia. Email: ; ; ; ;
authors.forename: Devon
authors.initials: D
authors.lastname: Indig
authors.affiliation: Justice Health and Forensic Mental Health Network, Suite 302, Level 2, 152 Bunnerong Rd, Eastgardens, NSW 2036, Australia. Email: ; ; ; ;
authors.forename: Shani
authors.initials: S
authors.lastname: Prosser
authors.affiliation: Justice Health and Forensic Mental Health Network, Suite 302, Level 2, 152 Bunnerong Rd, Eastgardens, NSW 2036, Australia. Email: ; ; ; ;
authors.forename: Shona
authors.initials: S
authors.lastname: Macleod
authors.affiliation: Justice Health and Forensic Mental Health Network, Suite 302, Level 2, 152 Bunnerong Rd, Eastgardens, NSW 2036, Australia. Email: ; ; ; ;
authors.forename: Adrian
authors.initials: A
authors.lastname: Keller
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D017144:Focus Groups; D005555:Forensic Psychiatry; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology; D008875:Middle Aged; D009517:New South Wales; D019982:Organizational Case Studies; D016134:Organizational Policy; D061845:Smoke-Free Policy; D011795:Surveys and Questionnaires