title: Preparing for Completely Smoke-Free Mental Health Settings: Findings on Patient Smoking, Resources Spent Facilitating Smoking Breaks, and the Role of Smoking in Reported Incidents from a Large Mental Health Trust in England.
abstract: BACKGROUND
  Despite high smoking prevalence and excessive smoking-related morbidity and mortality among people with mental disorder compared to the general population, smoking treatment is often neglected in mental health settings. The UK National Institute of Health and Clinical Excellence (NICE) recently issued public health guidance stipulating completely smoke-free mental health settings. This project evaluated existing smoking-related practices in preparation for guidance implementation. The objectives were to: audit the recording of smoking-related information and treatment provision; explore current arrangements relating to the facilitation of patient smoking; measure staff time spent and identify costs of facilitating smoking; and explore the role of smoking in smoking-related incidents.
  
  
  METHODS
  A mixed-methods study was conducted across four acute adult mental health wards, accommodating 16 patients each, over six months. It included a case-note audit, on-site observations, and a qualitative content analysis of incident reports.
  
  
  RESULTS
  Smoking status was recorded for less than half of the 290 patients admitted (138, 48%). Of those, 98 (71%) were recorded as current smokers, of whom 72 (74%) had received brief smoking cessation advice. Staff spent 6028 h facilitating smoking, representing an annual cost of £ 131,040 across four wards. Incident reports demonstrated that smoking facilitation was often central to the cause of incidences, triggered frustration in patients, and strained staff resources.
  
  
  CONCLUSIONS
  The findings highlight the importance and potential of implementing completely smoke-free policies using comprehensive pathways.
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology &amp; Public Health, University of Nottingham, Nottingham NG5 1PB, UK. Harpreet.Sohal@nottingham.ac.uk.
authors.forename: Harpreet
authors.initials: H
authors.lastname: Sohal
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology &amp; Public Health, University of Nottingham, Nottingham NG5 1PB, UK. Lisa.Huddlestone@nottingham.ac.uk.
authors.forename: Lisa
authors.initials: L
authors.lastname: Huddlestone
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology &amp; Public Health, University of Nottingham, Nottingham NG5 1PB, UK. Elena.Ratschen@nottingham.ac.uk.
authors.forename: Elena
authors.initials: E
authors.lastname: Ratschen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000331:legislation & jurisprudence* / Q000592:standards*; D008875:Middle Aged; D012308:Risk Management; D061845:Smoke-Free Policy / Q000331:legislation & jurisprudence*; D012907:Smoking / Q000523:psychology* / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology*
keywords: NICE PH48; mental disorder; mental health; nicotine dependence; psychiatric settings; smoke-free policy; smoking; smoking cessation; tobacco dependence