Mixed attitudes among staff towards smoking in large psychiatric hospital

Smoking is the single greatest cause of preventable illness and premature death in the UK, killing over 120,000 people annually. Rates of smoking among psychiatric patients are much higher than the rate of 27% found in the UK general population. For example, a survey of patients in a medium secure unit in the UK reported that 84% were smokers.

There is, however, little information available about levels of smoking amongst mental health professionals. What research there is indicates that smoking rates are higher amongst psychiatric unit staff than in the general population.

In the UK, many psychiatric units permit patients, and sometimes staff, to smoke in designated areas, but central policy now requires health care trusts to move towards being smoke-free (Health Development Agency, 2001). Persuading psychiatric patients to stop smoking, however, is very difficult.

This study, published in the June issue of the Psychiatric Bulletin, analysed responses to a postal questionnaire sent to all clinical staff (1471) in a large psychiatric hospital in Northampton, asking about their smoking habits and attitudes to smoking at work.

The overall response rate was 40.7%, with psychiatrists responding most often and nurses least often. 22% of respondents were smokers, with unqualified nurses having the highest rate (31%). The rate for psychiatrists was zero; for qualified nurses 17.4%, and other clinical professions 7.7%.

Most staff believed that exposure to tobacco smoke could shorten their lives (86.2%). Non-smokers were more concerned about this than smokers (91.8% v. 66.1%); and non-smokers were also more likely to favour a total ban on smoking on the wards by staff, patients and visitors. The majority of staff did not favour such a ban.

Almost all respondents thought that patients should be allowed to smoke in designated areas (94%), and that patients became less calm if they could not have cigarettes. Of the 132 respondents who smoked, 47.7% said they wished they could stop, although 56.1% cited job stress as a barrier to stopping smoking.

Psychiatrists were more likely than nurses to favour a total ban on staff smoking and, in particular, on staff smoking with patients. However, 26.3% of psychiatrists believed that staff smoking with patients was of value in creating therapeutic relationships; and 53% of nurses thought that it was.

No psychiatrist believed that cigarettes should be handed out to patients to achieve therapeutic goals; by contrast, 22% of nurses supported this view. All psychiatrists thought that patients who smoke should be encouraged to cut down and stop; 12.1% of nurses did not agree with this.

The authors of the study conclude that smokers and nurses were more permissive in their attitudes towards smoking on wards than non-smokers and psychiatrists.

Implementation of the government’s recommendation on tobacco control in psychiatric units is likely to require considerable preparatory work with staff, especially those who smoke, to ensure full compliance.

A bigger step would be to make all psychiatric units smoke-free. In North America, such policies have been implemented successfully, with fewer difficulties than staff anticipated.

Although we in the UK are moving slowly but steadily towards smoke-free hospitals, psychiatric units are likely to be one of the last places to continue to permit smoking, at least for patients.

For further information or a press copy of the full article, contact Deborah Hart or Thomas Kennedy in the External Affairs Department. Tel: 020 7235 2351 exts. 127 or 154. E-mail: [email protected].