Department of Epidemiology and Public Health, University of Nottingham, City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
Leeds and York Partnership NHS Foundation Trust, Becklin Centre, Alma Street, Leeds, LS9 7BE, UK.
BMC Health Serv Res. 2018 Jul 11;18(1):542. doi: 10.1186/s12913-018-3320-6.
Tobacco smoking is extremely prevalent in people with severe mental illness (SMI) and has been recognised as the main contributor to widening health inequalities in this population. Historically, smoking has been deeply entrenched in the culture of mental health settings in the UK, and until recently, smokefree policies tended to be only partially implemented. However, recent national guidance and the government's tobacco control plan now call for the implementation of complete smokefree policies. Many mental health Trusts across the UK are currently in the process of implementing the new guidance, but little is known about the impact of and experience with policy implementation.
This paper reports findings from a mixed-methods evaluation of policy implementation across 12 wards in a large mental health Trust in England. Quantitative data were collected and compared before and after implementation of NICE guidance PH48 and referred to 1) identification and treatment of tobacco dependence, 2) smoking-related incident reporting, and 3) prescribing of psychotropic medication. A qualitative exploration of the experience of inpatients was also carried out. Descriptive statistical analyses were performed, and the feasibility of collecting relevant and complete data for each quantitative component was assessed. Qualitative data were analysed using thematic framework analysis.
Following implementation of the complete smokefree policy, increases in the numbers of patients offered smoking cessation advice (72% compared to 38%) were identified. While incident reports demonstrated a decrease in challenging behaviour during the post-PH48 period (6% compared to 23%), incidents relating to the concealment of smoking materials increased (10% compared to 2%). Patients reported encouraging changes in smoking behaviour and motivation to maintain change after discharge. However, implementation issues challenging full policy implementation, including covert facilitation of smoking by staff, were reported, and difficulties in collecting relevant and complete data for comprehensive evaluation purposes identified.
Overall, the implementation of complete smokefree policies in mental health settings may currently be undermined by partial support. Strategies to enhance support and the establishment of suitable data collection pathways to monitor progress are required.
烟草在患有严重精神疾病（SMI）的人群中极为普遍，并且被认为是导致该人群健康不平等加剧的主要因素。从历史上看，吸烟在英国的心理健康机构文化中根深蒂固，直到最近，无烟政策才开始部分实施。然而，最近的国家指导方针和政府的烟草控制计划现在呼吁实施全面无烟政策。英国许多精神卫生信托机构目前正在实施新的指导方针，但对政策实施的影响和经验知之甚少。
本文报告了对英格兰一家大型精神卫生信托机构的 12 个病房实施政策的混合方法评估结果。在实施 NICE 指南 PH48 前后收集并比较了定量数据，并参考了以下内容：1）识别和治疗烟草依赖，2）与吸烟有关的事件报告，3）精神药物的处方。还对住院患者的经验进行了定性探索。进行了描述性统计分析，并评估了每个定量组成部分收集相关和完整数据的可行性。定性数据使用主题框架分析进行分析。
在实施全面无烟政策后，接受戒烟建议的患者人数增加（72% 相比 38%）。虽然事件报告显示 PH48 后期间挑战性行为减少（6% 相比 23%），但与隐藏吸烟材料有关的事件增加（10% 相比 2%）。患者报告称，吸烟行为有所改善，并在出院后保持改变的动机。然而，据报道，实施过程中存在一些问题，难以全面实施无烟政策，包括工作人员暗中协助吸烟，并且在全面评估目的方面收集相关和完整数据存在困难。
总体而言，在心理健康机构实施全面无烟政策目前可能受到部分支持的影响。需要采取措施加强支持并建立合适的数据收集途径来监测进展。
