Clearing the air : debating smoke-free policies in psychiatric units.

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There are about 34,000 people resident in mental health facilities in England and Wales on any one day (Commission for Healthcare Audit and Inspection 2005) and many of them smoke. Most facilities allow smoking in a designated indoor area, thus exposing patients and staff to second-hand smoke. Smoking and exposure to second-hand smoke lead to poor physical health, yet policy-makers, health practitioners and voluntary sector organisations representing patients and carers have been reluctant to extend the proposed ban on indoor smoking to residential institutions such as psychiatric units. Our findings suggest that many people with mental illness smoke and that this has a serious impact on their physical health. International and local examples show that it is possible to introduce a ban on indoor smoking, while allowing supervised smoking outdoors. However, our survey suggests that the greatest challenge to doing so will be overcoming staff fears about provoking violence in patients and the belief that patients need nicotine to cope with stressful situations. Institutions that have banned indoor smoking educated their staff and patients about the ban, provided smoking cessation aids and did not find that the ban provoked violence among patients. [Introduction]

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