Over 40% of all cigarettes smoked in England are smoked by people with severe mental illnesses. This group are more likely to become physically ill than the rest of the population, but they are less likely to be given help to quit.
Smoking is especially common among people with mental health problems: whilst 1 in 5 of the general population smokes, the figure rises to 1 in 3 among people with longstanding mental illness.
New public health guidance from NICE out this week looks to tackle these issues by helping people using acute, maternity and mental health services to stop smoking.
Recommendations
The new guidance recommends:
Where do you stand on this potentially explosive issue?
- Strong leadership and management to ensure premises remain smoke-free
- All hospitals have an on-site stop smoking service
- Identifying people who smoke, offering advice and support to stop
- Providing intensive behavioural support and pharmacotherapy as an integral component of secondary care
- Integrating stop smoking support in secondary care with support provided by community-based services
- Ensuring staff are trained to support people to stop smoking while using secondary care services
- Supporting staff to stop smoking or to abstain while at work
- Ensuring there are no designated smoking areas or staff-facilitated smoking breaks for anyone using secondary care services
As usual with this kind of NICE publication, there are a host of documents and resources to inform and bamboozle, pretty much in equal measure. The main links to the guidance itself, the supporting evidence, the relevant pathway and NHS staff podcast are all included below.
Sue Bailey, President of the Royal College of Psychiatrists, said:
There is a common but mistaken belief among some mental health professionals that it’s alright for patients in their care to smoke. This is wrong. Patients with mental health problems are far more likely to smoke than the general population, they suffer disproportionately higher rates of physical illnesses, and they die earlier. It’s a disgrace that this section of our NHS patient population is left to suffer the consequences of smoking.
Mary Yates, Matron at the South London and Maudsley NHS Trust said:
Having been actively involved in a smoke-free pilot in the South London and Maudsley NHS Foundation Trust, I have seen many patients with serious mental health problems cut down and successfully quit smoking whilst in our care. The new NICE guidance can help to change the culture whereby smoking is acceptable on NHS grounds and make it easier for hospital staff to set a clear example in helping patients to be successful in their attempt to quit smoking for good.
Paul Jenkins, CEO of Rethink Mental Illness said:
This new guidance is really important and timely. It is scandalous that so many people with mental illness are currently given no support to stop smoking.
What do you think of this new guidance?
We’d love to hear your thoughts:
- Should mental health patients be encouraged to stop smoking when they are admitted to hospital with an acute illness?
- Should NHS staff be forced to abstain from smoking at work?
- Do you have personal experience of trying to quit smoking whilst mentally ill?
- What’s the evidence regarding nicotine withdrawal and various mental health conditions?
Please share your thoughts in the comment box below.
Links
PH48 Smoking cessation – acute, maternity and mental health services: guidance (PDF). NICE, 27 Nov 2013.
PH48 Smoking cessation – acute, maternity and mental health services: supporting evidence. NICE, 25 Nov 2013.
Smoking cessation in secondary care. NICE pathway, 2013.
PH48 Smoking cessation in secondary care: podcast for staff working within mental health trusts. NICE, 27 Nov 2013.
New NICE guidance recommends that all NHS hospitals and clinics become completely smoke-free: Over 40% of all … http://t.co/XdiedEbMf9
Over 40% of all cigarettes smoked in England are smoked by people with severe mental illnesses http://t.co/e1tNv7d6BJ
@Mental_Elf some of whom learned to smoke in an MHU great therapy technique #youmustbekidding?
@Mental_Elf And getting NHS mental health trusts to be smoke free by 2015 will be a huge challenge, also for the staff.#mentalhealth
@Mental_Elf I started smoking whilst pt on a MH unit. Was the only way to relieve boredom & escorted time in garden (by staff who smoked)
@Mental_Elf its only f*****g things keeps me going – and tea, gallons of it
@Mental_Elf I heard on good authority staff will be stopped from taking fag breaks, more than 5 times a day in some cases. Insurrection?!
@RoslynByfield @Mental_Elf Non-smokers weren’t given the opportunity to take a break & stare into space for 5 mins every hour! #justsaying
@RoslynByfield @Mental_Elf Substitute fags U can buy now? Otherwise U could end up with uptight staff who don’t/can’t perform well at work!
@FmsAlexandra @nurse_w_glasses @RoslynByfield @Mental_Elf when I was a student nurse we were encouraged to sit in the day room & smoke with>
@FmsAlexandra @nurse_w_glasses @RoslynByfield @Mental_Elf >with the patients to encourage interaction and normalisation.
@RoslynByfield @Mental_Elf About time too!!!!
@Mental_Elf South London and Maudsley have developed a mental health specific smoking cessation elearning for staff
@Mental_Elf I know some people start smoking while on bedrest on an eating disorders ward – it’s the only way they were allowed outside.
@Mental_Elf @nurse_w_glasses Apparently smoking is a human right, but not being trapped within four walls for weeks on end isn’t.
RT @Mental_Elf: Over 40% of all cigarettes smoked in England are smoked by people with severe mental illnesses http://t.co/C6NH28X825 <Wow
New NICE guidance recommends that all NHS hospitals and clinics become completely smoke-free – See more at: http://www.thementalelf.net/mental-health-conditions/substance-misuse/new-nice-guidance-recommends-that-all-nhs-hospitals-and-clinics-become-completely-smoke-free/#sthash.pY4OngJC.dpuf
In psychiatric units, 70% of people smoke http://t.co/e1tNv7d6BJ
@Mental_Elf. We have an obligation to fight deadly #addiction. #smoking kills our patients 25yrs earlier than people without #mentalillness
@DrIanDawe @Mental_Elf Agreed. When when our water, food & air stops being poisoned, I might jump on that band wagon.
@mental_elf agree this is important issue to raise and address but very uncomfortable with this 70% figure. It is survey data from 2000…
@mental_elf …Predates smoking ban and smoking cessation services targeting service users. Invalid figures for me, potential to skew debate
New NICE guidance recommends that all NHS hospitals and clinics become completely smoke-free via @Mental_Elf http://t.co/4XHipRZHh4
From a public health perspective – this new guidance is very welcome. I can foresee the following benefits:
1) reducing inequalities of smoke exposure (especially for mental health patients)
2) Trusts leading by example by encouraging a smoke-free NHS culture
3) empower NHS staff to ensure they are Making Every Contact Count
MH patients should be treated the same as patients with physical health issues. As such, any MH patient who is identified to be a smoker should be provided with brief advice and encouraged/supported to stop smoking. This may require a large culture shift for many trusts, but this is necessary and will help improve the health and well-being of patients – which surely, is what we all want!
RT @Mental_Elf We want your tweets on #Smoking & #MentalHealth. Join in discussions about new @NICEcomms guidance http://t.co/c35AlIZ4hU
RT @Mental_Elf: We want your tweets on #Smoking & #MentalHealth today. Join in with the discussions about the new @NICEcomms guidance http:…
Should mental health patients be encouraged to stop smoking when they are admitted to hospital with an acute illness? http://t.co/e1tNv7d6BJ
@Mental_Elf Yes, as part of preventative risk. Especially as many psych drugs give increased risk cardiac disease. Encouraged but not forced
@Mental_Elf won`t have any choice
@Mental_Elf This would prob be the worst time to give up & I doubt it would lead to long term success.
@Mental_Elf MH pts need targeted & appropriate cessation support. I was refused NHS help at GP surgery due to MH problem.
@lucy_seren @Mental_Elf WHY??
@buletproofcardi @Mental_Elf Inappropriate as it was group based! (they didn’t expand on this), I was advised to contact CMHT.
@lucy_seren @Mental_Elf That’s appalling!
@Mental_Elf Smoking when suffering from an eating disorder for example would need a very different approach/treatment.
Thanks for your comments @lucy_seren Really interesting! Please post a full response in the comments on my blog: http://t.co/e1tNv7d6BJ
@Mental_Elf not the best time in their lives. Get NICE staff out to try implement ha ha
@Mental_Elf Why not. Everyone else is……….
@Mental_Elf #addiction #alcohol #cigarette #food #sex #gambling bans won’t stop #mentalillness
@Mental_Elf what about band unhealty food on NHS property. All vending machines sweet shops & cafes to go – equality of public health!
@DrGertya @Mental_Elf I have often wondered about the unhealthy food available to buy in many hospitals.
@Mental_Elf Absolutely NOT.Most stressful time.So cruel. Would you deny someone who’s just suffered huge trauma a fag? It’s a recovery goal.
NICE richtlijn met aanbevelingen om psychiatrische patiënten aan te moedigen #roken te stoppen. #ggz http://t.co/otI2mJpuC3
“@RobertVermeiren: NICE richtlijn met aanbevelingen om psychiatrische patiënten aan te moedigen #roken te stoppen. http://t.co/qpXwkj021u”
70% van opgenomen #ggz patiënten rookt. NICE richtlijn wil daar wat aan veranderen. http://t.co/otI2mJpuC3
Share your views in the comments: Should mental health patients have to stop smoking in acute admissions? http://t.co/cCOu32ptYm @Mental_Elf
@Mental_Elf Cue the professionals moralising about what should be imposed on people with mental health problems at their most vulnerable.
@Sectioned_ @Mental_Elf But at our most vulnerable should we not have the support & protection that seriously physically unwell pts have?
@Sectioned_ @Mental_Elf It must be very rare for nursing staff to routinely take pts in cardiac units ‘out for a fag’ NRT offered maybe.
@lucy_seren It must be very rare for nursing staff to come in gangs of 6 & wordlessly pin down & inject cardiac patients. @Mental_Elf
@Sectioned_ @Mental_Elf There would be public outcry & assault charges if this occured! Why this is okay in MH I don’t know. Barbaric.
@lucy_seren Yes. There’s a lot needs fixing in psychiatric care to make it a supportive rather than coercive environment. @Mental_Elf
@lucy_seren Yes, psychiatric inpatient wards should be supportive environments that nurture mental & physical health. @Mental_Elf
@Sectioned_ @Mental_Elf choice to be valued above all, unless it could be harmful. And not really seeing the acute harm of smoking shelters.
@PsychiatrySHO @Sectioned_ @Mental_Elf I think this is where public health based on numbers runs head on into public health made of people
@PsychiatrySHO @Sectioned_ @Mental_Elf do wonder what’d happen if similar muscular approach were taken to other known public health factors
@PsychiatrySHO @Sectioned_ @Mental_Elf like, say, ‘no patient discharged to a unsafe home’ or ‘sexual violence to be removed’
@MarkOneinFour @Sectioned_ @Mental_Elf single biggest factor in quitting is wanting to quit. Banning smoking in hospitals doesn’t fix this.
@PsychiatrySHO Stopping smoking successfully combines desire AND the right method/sufficient support. @MarkOneinFour @Mental_Elf
@MarkOneinFour @Sectioned_ @Mental_Elf but I know that @ProfLAppleby has worked on this issue and feels it’s a good idea. Thoughts?
@PsychiatrySHO Yes, psychiatric inpatient wards should be supportive environments that nurture mental & physical health. @Mental_Elf
@PsychiatrySHO Nurturing mental & physical health would include decent food, therapies, physical healthcare, cessation support. @Mental_Elf
@Sectioned_ @Mental_Elf in fact I’m pretty sure going nicotine cold turkey isn’t going to help anyone. Good opportunity to offer NRT tho.
@Sectioned_ @Mental_Elf most important is to get a bed in first place then right meds to help stabilise mood,sleep & eat by encouragement.
@Sectioned_ @Mental_Elf As a patient I’d really like to not have smoking imposed on me
@moylan_a Yes, the ward physical environment is important. A smoking section in an accessible outdoor space helps with that. @Mental_Elf
@Sectioned_ @Mental_Elf It’s often the only shared outdoor soace
@moylan_a Many wards have no accessible outdoor space, requiring nurses to escort patients at intervals. That causes problems. @Mental_Elf
@Sectioned_ @Mental_Elf Indeed
@Sectioned_ @Mental_Elf no they should be offered info n advise support if they want to but that’s it
@444blackcat Yes. Psychiatric inpatient wards should be supportive environments that nurture mental & physical health. @Mental_Elf
@Sectioned_ @Mental_Elf @444blackcat if you know of one please let me know ASAP, not the description of the ones I have resided in so far!!
@bipolargran Yes, enforcing a smoking ban in a coercive environment when you’re vulnerable is not supportive. @Mental_Elf @444blackcat
@Sectioned_ @Mental_Elf @444blackcat I speak as a non smoker but acute MH unit worst place to try to give up i wd think.Achievable goals pls
@Sectioned_ @Mental_Elf @444blackcat health & wellbeing shd be part of inpatient care plan & option to refer to take further on discharge
I agree. The goals lay elsewhere for initial acute MH care @444blackcat @Sectioned_ @Mental_Elf + advice later. Health impacts signif tho’
Some of my thoughts on smokers on psychiatric wards http://t.co/kGxOqFtLTn @Mental_Elf
Here’s @nurse_w_glasses on a smoking ban for mental health workers at the workplace http://t.co/KVD6aZ1zjQ @Mental_Elf
@Sectioned_ @Mental_Elf Christ no. Don’t add to the stresses of those already unable to cope!
@Sectioned_ @Mental_Elf Secondhand smoke makes me sick but I don’t see a good reason to prevent it. Provide smoking areas for the addicted.
@Sectioned_ @Mental_Elf personally quitting smoking when I was at rock bottom was really not an option. Was focusing on rebuilding myself…
@Sectioned_ @Mental_Elf …however I’d never impose it on others around me. We had our own area at my hospital. And it was never limited.
@Sectioned_ @Mental_Elf In hospital, I saw many people stressed w/out cigarettes, so much that they were unable to work on their mh issues
@Sectioned_ @Mental_Elf Smoking Mad! Banning smoking on Inpatient Wards is a human rights issue http://t.co/aNaiJA6Iuv
@Sectioned_ @Mental_Elf PT has right to choose if they wish to smoke, but some sectioned have no choice as not allowed outside for smoko
@Girl_Interrupt_ That depends on the ward environment: a well-designed ward has a smoking section in an accessible garden. @Mental_Elf
@Sectioned_ @qmulbioethics @Mental_Elf social #inequalities affect #smoking rates, #nhs shd cherish staff & patients who still #smoke @FPH
@jackiecassell Yes, psychiatric wards should cherish, nurture & support people with mental health problems. @qmulbioethics @Mental_Elf @FPH
@Sectioned_ @Mental_Elf If you ban smoking on psych wards, levels of agitation will increase in patients. I think this could hamper recovery
@LawdyMissClawdy What increases agitation is wards without access to outdoor space leading to escorted smoking breaks. @Mental_Elf
@LawdyMissClawdy If every ward had an accessible outdoor space with a smoking area, smoking cessation could be supported. @Mental_Elf
@LawdyMissClawdy Seeing an acute admission as an opportunity to impose further restrictions won’t help people stop smoking. @Mental_Elf
@LawdyMissClawdy Instead, it’s just another example of professionals moralising & infantilising people with MH problens. @Mental_Elf
@LawdyMissClawdy Successful smoking cessation has a number of elements, just as it does for people without mental ill health. @Mental_Elf
@LawdyMissClawdy It’s silly when moralisers portray mental health patients as a homogenous unit upon which to impose one fix. @Mental_Elf
@Sectioned_ @LawdyMissClawdy @Mental_Elf Absolutely agree, one size never fits all. Lack of support meant I gave up, choice not control!
@Sectioned_ @Mental_Elf @LawdyMissClawdy When people have so little control in their environment, controlling smoking seems cruel.
@LawdyMissClawdy @Mental_Elf @Sectioned_ Agitation. Even on meds with nicotine puffers etc Ive climbed walls when not allowed to smoke
@floellaella Yes, many use smoking as a coping mechanism & to take that away at a time of acute crisis sucks. @LawdyMissClawdy @Mental_Elf
@LawdyMissClawdy @floellaella @Sectioned_ @Mental_Elf have they considered e-cigs as a replacement?
@trabasack @LawdyMissClawdy @Sectioned_ @Mental_Elf should do
@trabasack Smokers I know get on really well with vaping & have cut down smoking as a result. @LawdyMissClawdy @floellaella @Mental_Elf
@trabasack @floellaella @Sectioned_ @Mental_Elf e-cigarettes have been banned from the wards due to fire risk.
@Sectioned_ @Mental_Elf Fire risk on psych wards will increase as more will try to smoke surreptitiously in their rooms.
@LawdyMissClawdy Patients smoked in their rooms & far bathrooms in the ward I was detained as there was no accessible garden. @Mental_Elf
@LawdyMissClawdy A solution would be to design wards for how people are – ie with accessible spaces with smoking sections. @Mental_Elf
@Sectioned_ @Mental_Elf no, MH patients shouldn’t have to stop, everyone should! Smoking has terrible, avoidable consequences as we all know
This blog from Roy Lilley is well worth a read:
Where does Alfie fit?
http://campaign.r20.constantcontact.com/render?llr=zfxea5cab&v=001fgXe_62hM0kvGiWdLDOjRZAdXeZptCYe8YPP3sqPPyLIRSl2e8jq1QG3InBQ2SjLz6dZTP4J4pbe-sVYMgub6ialrZTXBD_qV15LPMHqcrpEcPrH3ENIQxf99CZXAfJ_0FBQllWQmu_D-XaIT3WC2GTHP7GSD_sb
Another very relevant blog is this one from Dr Paul Morgan:
Smoking in hospitals – is a complete ban essential or even desirable?
http://drpaulmorgan.wordpress.com/2013/11/27/smoking-in-hospitals-is-a-complete-ban-essential-or-even-desirable/
Should NHS staff be forced to abstain from smoking at work? http://t.co/e1tNv7d6BJ
@Mental_Elf I have experienced irony of being a non-smoker in rehab with no smoke-free place to go. Nicotine OK but not allowed caffeine!
@Mental_Elf Or eating unhealthy foods? Or drinking Coke? Or using their mobile phones? Good luck with that.
I think Dr Paul Morgan’s blog usefully gets to the heart of challenges and grey areas eg who would police such a ban, but also the potentially harmful timing of such bans when people are feeling vulnerable. But apparently commissioners are being encouraged (told?) to only commission services from organizations which practise such a ban so they will have the service providers over a barrel. This could lead to a widespread discrepancy between policy and practice, any bans being flouted ‘at the coalface’.
Do you have personal experience of trying to quit smoking whilst mentally ill? http://t.co/e1tNv7d6BJ
@Mental_Elf I’m down to two a day! It’s progress!
What’s the evidence for nicotine withdrawal and mental illness? Should people quit smoking when acutely ill? http://t.co/e1tNv7d6BJ
My e cig was retained in the office, started smoking again whilst on ward. Need to get good advice about e cigs in NHS. Have since gone back to e cig.
Thanks+ to everyone who joined our chat on #SmokingCessation & #MentalHealth today. Keep on commenting on the blog: http://t.co/e1tNv7d6BJ
http://t.co/oaFJRqw38r
RT @Mental_Elf: In case you missed it: New NICE guidance recommends that all NHS hospitals and clinics become completely smoke-free http://…
New NICE guidance recommends that all NHS hospitals and clinics become completely smoke-free http://t.co/l18HPwLLx8 via @sharethis
NICE recommends that all #NHS hospitals & clinics become completely smoke-free http://t.co/YihZIDbJ05 @nurse_w_glasses via @ThinkSpeakThink
Mental Elf: New NICE guidance recommends that all NHS hospitals and clinics become completely smoke-free http://t.co/l0Nm5GxYLd
New NICE guidance recommends that all NHS hospitals and clinics become completely smoke-free http://t.co/zKfzETmbji Ook gesloten afdelingen?
Do the new NICE guidelines for smoke-free hospitals and clinics infantilise mental health patients? MT @Mental_Elf http://t.co/DVUQT30lTX
@trishgreenhalgh @Mental_Elf I fear that they do – and increase risk as people may just go outside the grounds to smoke
@DocMartin68 @trishgreenhalgh @Mental_Elf But if we exclude mental health are we saying it doesn’t matter as much, OK for them to smoke?
@DocMartin68 @trishgreenhalgh @Mental_Elf Mortality in chronic MH largely due to physical problems & smoking major factor. R we nihilistic?
@DocMartin68 @trishgreenhalgh @Mental_Elf http://t.co/cKCrKzpJqb
This is reality!
@trishgreenhalgh @Mental_Elf Errr, or does the lack of tobacco-free policy suggests lack of interest in mental health care/outcomes?
@trishgreenhalgh @Mental_Elf is there a need for healthy food guidelines for staff and patients ? No chocolates or supper on MH Wards ?
As a doctor with a long history of mental health issues (bipolar) here are my thoughts about imposing a smoking ban on hospital in-patients: –
There are those who think that for some reason psychiatric in-patients should be treated differently when it comes to the proposed in-patient smoking ban. Personally, I feel it is even more important for psychiatric patients, including in-patients, to be encouraged to stop smoking. It is well known that people with mental health problems are more likely to smoke and that most of those who do smoke want help to stop smoking. There is plenty of evidence that smoking makes mental health symptoms worse, and that stopping smoking is beneficial for people with mental health problems in the long term. Also patients with long-term psychiatric conditions are at increased risk of co-morbidities such as diabetes, lung disease & heart disease.
What better time to try and start to tackle this issue than during an in-patient stay? Why should smoking be treated any differently during an acute admission than other addictions such as alcoholism or heroin addiction?
I happily admit that I am biased in my opinions about this because of my own personal experience.
In 2003 I was admitted twice 6 weeks apart with puerperal psychosis to a well-known private psychiatric hospital (on the NHS). The first admission was compulsory under the MHA, the second was voluntary. The ASW in her wisdom decided to send me to a hospital 50 miles away from home so that I wouldn’t be recognised by anyone. Subsequently I was 50 miles away from friends and family including my 6 week old baby. When I arrived at the hospital in my psychotic state I believed I was being taken there to be killed. Being pinned down by several members of staff and forcibly injected with ativan only reinforced that view. For the first few days of my first admission I was confined to my room on a 1 to 1. I couldn’t go to the loo without leaving the door ajar because I couldn’t be trusted. But then gradually they allowed me more freedom.
I have never smoked. During my 2 two week stays because of this I was subject to virtual self-imposed solitary confinement in my room even when I was deemed to be well enough to leave it. At the time smoking was allowed indoors in a conservatory at the back of the patients’ lounge, separated from the main TV lounge by a glass door which was always left open. Subsequently, the patients’ lounge was a completely disgusting place; it was either thick with smoke, or in the early mornings smelled heavily of stale smoke. I went into the conservatory on one occasion to sit and talk to the other patients and actually couldn’t see them through the smog. I would estimate that >90% of the in-patients were smokers and they dominated the place. As a lifelong non-smoker I had no desire to go anyway near the lounge, but there was nowhere else to go. There was nothing else to do. I would wander around aimlessly and go to the kitchen and stare out at the garden and then wander back to my room. It was a very lonely time. Admittedly there was some structure to our days; we had OT sessions to attend; in between these we were left to our own devices; but there were no other facilities at all on site. I have no idea how I got better; I suppose it was the desperation to get out of that situation. And the smokers who went to the lounge chain-smoked all day; they were bored. They had nothing else to do.
These days I’m informed that most psychiatric patients aren’t allowed to smoke indoors but instead they are taken outside by nurses. At least they aren’t subjecting their fellow in-mates to secondhand smoke anymore. But psychiatric nurses did not spend years of training to become psychiatric nurses to learn how to accompany people outside to smoke. And, how can it be argued that they should accompany patients outside to smoke when smoking is basically a form of self-harm? And the time taken up accompanying patients outside to smoke is time away from other patients.
There is something fundamentally very wrong with in-patient psychiatric care. Being a psychiatric in-patient is frightening, lonely and extremely boring, and also arguably totally un-therapeutic.
In my opinion psychiatric patients need far more structure to their day with the opportunity for time outdoors – accompanied if necessary – and also what about some healthy on-site leisure facilities such as a gym? Going back to my personal experience, thanks to my medication I gained a stone and half in weight during my in-patient experiences with the subsequent detrimental effect on my self-image; if there had been a treadmill to hand, maybe I wouldn’t have? For me these days regular exercise is the mainstay by which I remain well. I would argue that it is a much more effective form of anxiety-relief than smoking and is obviously a much more healthy option. Having a gym on-site in psychiatric units and even employing an instructor to run it would make a lot of sense to me.
Doesn’t anyone think this is big brother at its worse..what happened to peoples human rights and thier right to choose to smoke. People with the most severe mental health problems in secure units are not being given any choice at all. Its a disgrace that this is being enforced. Somebody please put a stop to it.
[…] Since July 2008, mental health facilities in England have had indoor smoking bans. However, NICE guidelines recommend that all NHS sites, including psychiatric hospitals become completely smoke-free, a recommendation previously examined by the Mental Elf. […]
“New public health guidance from NICE out this week looks to tackle these issues by helping people using acute, maternity and mental health services to stop smoking.” Let alone the question of patient choice, as to whether to stop smoking or not, who is making the choice as to the timing of such ‘interventions’? Why when the patient is an inpatient are we wanting to push this on them? What is wrong with smoking cessation being managed through Primary and Secondary Community Care? Another agenda, perhaps?
[…] New NICE guidance recommends that all NHS hospitals and clinics become completely smoke-free […]
My son has stopped smoking three times and started again while in a secure unit. That in my view a safe place. I now find he is in again at a new facility and guess what they are taken for a walk to have a smoke!!!! It uses more medication if one smokes. Unfortunately the staff smoke so they believe that the patients should be allowed to smoke too.