Smoke-Free Mental Health Services in Scotland Implementation Guidance

Smoke-free mental health services in Scotland Implementation guidance 1 We are happy to consider requests for other languages or formats. Please contact 0131 536 5500 or email [email protected] Acknowledgements I am indebted to members of the Advisory Group which was set up to assist me with the development of the implementation guidance, in particular Nigel Henderson, who chaired the group, and Celia Gardiner who provided liaison and support between group meetings. I am very grateful to Diane Laughtland who organised my visit to The State Hospital, and to Denise Meldrum who arranged for me to visit Leverndale Hospital. Many other individuals gave their time to contribute their views in interviews and their help has been invaluable in informing the nature and content of the implementation guidance. Linda Nicholson The Research Shop Published by NHS Health Scotland Edinburgh Office Woodburn House Canaan Lane Edinburgh EH10 4SG Glasgow Office Elphinstone House 65 West Regent Street Glasgow G2 2AF © NHS Health Scotland, 2011 ISBN: 978-1-84485-514-8 All rights reserved. Material contained in this publication may not be reproduced in whole or part without prior permission of NHS Health Scotland (or other copyright owners). While every effort is made to ensure that the information given here is accurate, no legal responsibility is accepted for any errors, omissions or misleading statements. NHS Health Scotland is a WHO Collaborating Centre for Health Promotion and Public Health Development. 2 Foreword Reducing smoking and the misery caused by tobacco-related harm is central to improving Scotland's health. Scotland has a proud history of leading the way on tobacco control, including being the first part of the UK to introduce legislation to ban smoking in substantially enclosed public places. As a result, we have seen a transformation in cultural attitudes to smoking over the last few years. This Smoke-free mental health services in Scotland: Implementation guidance is a further step in the journey towards a smoke-free Scotland. Allowing smoking in designated rooms in residential mental health services, when it is completely banned in all other NHS settings, perpetuates inequalities. Patients and staff who work in mental health settings should have the same opportunities to enjoy the benefits of a smoke-free environment as the rest of the NHS in Scotland. Within the context of the wider push to improve the physical and mental wellbeing of people with mental health problems, the guidance will support and encourage a move towards smoke- free settings at a pace which suits the services’ particular needs and circumstances. Our extensive consultation with service planners, deliverers and users suggests that this approach is preferable to the statutory smoking bans in residential psychiatric premises which have been in place elsewhere in the UK over the last couple of years. We do not underestimate the challenges faced in removing internal smoking rooms in residential mental health services. However, there is strong and emerging evidence that, with goodwill on all sides, smoke-free policies can be effectively implemented in these settings. The guidance offers a step-by-step approach to support the process of engagement with all concerned, including staff and patients who are most directly affected. Shona Robison MSP Minister for Public Health and Sport i Contents Introduction 1 Implementation toolkit 20 Reasons for going smoke-free 3 How to prepare for the implementation of your smoke-free policy 21 Relationship between smoking and mental health 4 The 10 step plan 22 Meaning of ‘smoke-free’ 5 Step 1: Establish leadership 23 Purpose of the implementation Step 2: Firm up your policy 26 guidance 6 Step 3: Define your plan 28 ‘A starting point rather than a recipe’ Lessons from the implementation of Step 4: Listen to views 31 smoke-free policies 8 Step 5: Provide smoking Five elements of successful cessation support 37 implementation of smoke-free policies 9 Step 6: Consider estate issues 43 Benefits to mental health service users of quitting smoking 9 Step 7: Staff training 45 Benefits to organisations and Step 8: Communicate your policy 50 staff of mental health service users quitting smoking 10 Step 9: Establish new protocols 52 Useful texts 11 Step 10: Monitoring and evaluation 55 Important policy decisions 14 Implementing your policy 58 Comprehensive or partial Support following discharge smoke-free policy? 16 from hospital 60 Phased or one-step implementation? 17 Useful contacts and resources 62 Exceptions to the rules? 18 Useful websites 64 References 65 Annex 1: Advisory Group membership 69 Annex 2: Scenarios for discussion 70 ii Introduction 1 Smoking has been banned in public Many mental health hospitals in Scotland places in Scotland since 2006 by virtue have already made considerable progress of the Smoking, Health and Social Care towards making their indoor premises (Scotland) Act 2005. However, the law smoke-free, and have introduced policies still exempts residential mental health which permit smoking in their grounds institutions from the ban and permits only, or in designated shelters within their smoking in designated indoor rooms grounds. Smokers have retained a choice in such settings. Other workplaces in about whether to smoke, but the hospital Scotland, including general hospitals, have or ward policy has set out where and successfully implemented the smoke-free when this is permitted. law. In Northern Ireland, enclosed areas of mental health premises became smoke- This guidance is primarily for mental free in April 2008, with England removing health service providers involved in a temporary exemption for mental health implementing smoke-free policies within institutions in July 2008. in-patient settings, but may also be useful in the context of community mental health In March 2010, following a public services, or settings involving service users consultation by the Scottish Government1, with learning disabilities. the Public Health Minister announced that guidance would be produced to help mental health service providers move towards banning smoking altogether. NHS Health Scotland was asked to lead on the process in consultation with stakeholders and with input from mental health nursing and allied health professional advisors. An Advisory Group2 was set up to assist with the development of the guidance, and Linda Nicholson from The Research Shop was commissioned to undertake the research groundwork and write the implementation guidance document. 1 The analysis of consultation responses is at: http://www.healthscotland.com/uploads/documents/12505-AchievingSmoke-FreeMentalHeal thServicesinScotlandReport0910.pdf 2 Membership of the Advisory Group is in Annex 1. Introduction 2 Reasons for going smoke-free Stakeholders interviewed for this guidance who have already introduced smoke-free 'There is an awful lot of stigma policies to mental health hospitals and around mental health. Pubs wards identified three reasons for doing so: don’t provide a smoking area › People with mental health problems where people with mental should not be treated in a different health problems can have way to other members of the public a cigarette; when you go to in terms of looking after their physical health. Continuing to permit smoking a sports centre they don’t in mental health institutions perpetuates have a smoke room where inequalities in the treatment of people people with mental health with mental health problems. problems can have a cigarette; › People with mental health problems if people with mental health are not allowed to smoke in public problems get admitted to a places when they live outside mental health hospitals, and allowing them general hospital they can’t go to smoke in mental health hospitals somewhere indoors to have a stigmatises them as different. cigarette. This is an issue about › Staff do not wish to be subjected to normalisation.' passive smoking and the associated Mental health service manager who is a harmful impacts on their physical smoker health. Staff in other workplaces in Scotland are not expected to work in environments where they breathe in second-hand smoke. Introduction 3 Relationship between smoking and mental health Facts about smoking and mental health Heavy smoking is associated in particular with schizophrenia. Nicotine in cigarettes › People with mental health problems appears to be especially reinforcing in are more likely to smoke; to be more people with schizophrenia, as it stimulates nicotine-dependent; to have smoked the subcortical reward system and the for longer; and to smoke more heavily prefrontal cortex, both of which appear than the general population (Campion to be hypofunctional in people with et al, 2008a). schizophrenia (Chambers et al, 2001). Whilst there are many reports in previous › Contrary to popular opinion, smoking literature of nicotine helping to alleviate is harmful to mental health. Smoking some of the negative symptoms of increases the risk of developing a schizophrenia (e.g. Patkar et al, 2002), mental health problem, with a clear the medical evidence on smoking as relationship identified between the self-medication remains inconclusive. amount of tobacco smoked and the There does seem to be a complex number of depressive and anxiety interaction between nicotine dependence symptoms in people with existing and schizophrenic symptoms (Aguilar et mental illness and those without al, 2005), but a systematic review found mental health problems

Load more