This article is more than 5 years old. Information may no longer be current.

Smoke-free policy may decrease violence in psychiatric settings

Implementation of a smoke-free policy in inpatient psychiatric wards was associated with a 39% decrease in physical assaults, according to recent findings.

“Tobacco withdrawal often prompts restlessness, irritability and a fixation on finding opportunities to smoke, and hospital staff understandably mistake this as a sign of worsening mental health. Smoking during a period of tobacco withdrawal only serves to reinforce this misinterpretation, as patients will appear calmer and less irritable as nicotine levels are topped up. This is incorrectly taken as evidence that smoking is therapeutic and necessary to prevent agitation,” study researcher Mary Yates, MSc, of South London and Maudsley NHS Foundation Trust, said in a press release.

To assess the effect of implementing a comprehensive smoke-free policy on physical assault rates in a large mental health organization in the U.K., researchers conducted an interrupted time series analysis of incident reports of physical assault 30 months before and 12 months after program implementation in inpatient wards.

From April 2012 through September 2015, 4,550 physical assaults occurred, of which 4.9% were related to smoking.

After adjusting for temporal and seasonal trends and confounders, including sex, age, schizophrenia or related disorder, or sectioning under the Mental Health Act, there was a 39% reduction in physical assaults per month after policy implementation, compared with preimplementation (IRR = 0.61; 95% CI, 0.53-0.7; P < .0001).

“Hopefully our findings will reassure staff that introducing a smoke-free policy does not increase physical violence as is often feared,” Debbie Robson, PhD, of King’s College London, said in a press release. “We believe there are a number of possibilities why rates of violence actually decreased. Historically, cigarettes have been used as a tool to manage patient behavior and patients often coerce their peers into handing over cigarettes. To support the introduction of the smoke-free policy [South London and Maudsley NHS Foundation Trust] invested in new treatment pathways for smokers and a staff training program, which may have contributed to changing the culture of how staff and patients interact.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.