title: Mental health professionals' perspectives on the implementation of smoke-free policies in psychiatric units across England.
abstract: BACKGROUND
  The original audit on which this 2013 secondary analysis is based, was conducted in 2010. It explored implementation of smoke-free policies from the perspective of unit managers in 147 psychiatric units across England comprising a randomly selected sample of nine different unit types.
  
  
  METHODS
  Two main themes are presented: positive perspectives of smoke-free policy implementation, and barriers and problems with smoke-free policy implementation. Analysis of unit managers' experiences and perspectives found that 96% of participants thought smoke-free policy had achieved positive outcomes for staff, patients, services and care.
  
  
  CONCLUSIONS
  Consistency of response was the most prominent factor associated with policy success. Quality of the physical environment and care delivery were clear positive outcomes which enabled the environment to be more conducive to supporting staffs' and patients' quit attempts. Lack of consistency and a prevailing culture of acceptance of smoking were identified as some of the most reported perceived continuing problems. Solutions included the need to acknowledge that this type of complex systems change takes time and ongoing staff education and training.
  
  
  CONCLUSIONS
  Our results demonstrate the importance of taking into account the experiences and attitudes of staff responsible for enacting smoke-free policy.
authors.affiliation: Department of Psychiatry, Flinders University, Adelaide, South Australia, Australia sharon.lawn@flinders.edu.au.
authors.forename: Sharon
authors.initials: S
authors.lastname: Lawn
authors.affiliation: Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Yi
authors.initials: Y
authors.lastname: Feng
authors.affiliation: Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Tsourtos
authors.affiliation: Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK Department of Population Mental Health, University College London, UCL Partners, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Campion
mesh_terms: D001291:Attitude of Health Personnel; D004739:England; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006757:Hospital Units / Q000331:legislation & jurisprudence*; D006801:Humans; D001523:Mental Disorders; D008603:Mental Health; D061845:Smoke-Free Policy / Q000331:legislation & jurisprudence*; D012907:Smoking; D011795:Surveys and Questionnaires
keywords: Smoke-free policy; implementation; mental health; psychiatric inpatient