Open Access Highly Accessed Research article

Observation of the extent of smoking in a mental health inpatient facility with a smoke-free policy

Paula Wye1234*, Leanne Beth Gow14, Jude Constable5, Jenny Bowman123, Sharon Lawn6 and John Wiggers1234

Author Affiliations

1 University of Newcastle, University Drive, Callaghan, New South Wales (NSW) 2308, Australia

2 Hunter Medical Research Institute (HMRI), Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia

3 University of Newcastle Priority Research Centre for Health Behaviour (PRCHB), Room 271, Level 2, David Maddison Building, Cnr King and Watt Streets, Newcastle, NSW 2300, Australia

4 Hunter New England Population Health (HNEPH), Longworth Ave, Wallsend, NSW 2287, Australia

5 Hunter New England Mental Health Service, Mater Hospital, Cnr Edith and Platt Streets, Waratah, NSW 2298, Australia

6 Department of Psychiatry, Flinders University, PO Box 2100, Adelaide, South Australia 5001, Australia

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BMC Psychiatry 2014, 14:94  doi:10.1186/1471-244X-14-94

Published: 29 March 2014



People with a mental illness experience a higher burden of smoking-related disease. Smoke-free policies in mental health facilities provide an opportunity to reduce smoking-related harms for patients and staff alike. Limited evidence regarding the effect of such policies on preventing smoking in mental health facilities has been reported. The aims of this study are to describe the extent of smoking and the provision of nicotine replacement therapy (NRT) to patients in a mental health facility with a smoke-free policy.


Cross-sectional studies of smoking (cigarette butt count and observed smoking) and nicotine dependence treatment (patient record audit) were undertaken over 9 consecutive weekdays in one mental health facility in Australia. A smoke-free policy incorporating a total smoking ban and guidelines for treating nicotine dependence among patients was implemented in the facility 4 years prior to the study.


Two thousand one hundred and thirty seven cigarette butts were collected and 152 occasions of people smoking were observed. Staff members were observed to enforce the policy on 66% of occasions. Use of NRT was recorded for 53% of patients who were smokers.


Implementation of the smoke-free policy was less than optimal and as a consequence ineffective in eliminating smoking and in optimising the provision of NRT. Additional strategies to improve the provision of nicotine dependence treatment to patients and the monitoring of adherence are needed to ensure the intended benefits of smoke-free policies are realised.

Nicotine dependence treatment; Smoke-free policy; Mental health; Smoking