Concerns over smoking ban

Consultations needed before making mental health units smoke-free

NSW Health has delayed the introduction of a total ban on smoking in mental health units in response to concerns raised by the NSW Nurses’ Association.

After the NSWNA raised concerns with NSW Health, the Department asked Chief Executives to put the ban on hold until it could thoroughly research the implications, consult with stakeholders including the union, and develop best practice guidelines.

NSW Health has progressively introduced a smoking ban in health care environments, including outdoor areas. The ban extends to staff, patients and visitors with provisions for permanent exemptions for certain patient groups, including mental health patients.

Despite this, some health services such as Hunter New England Area Health Service have introduced complete smoking bans in mental health units.

North Coast Area Health Service has convened a consultative committee to help plan their move to smoke-free mental health units, with a pilot expected at Coffs Harbour Base Hospital.

NSW Health policy is to provide patients with nicotine replacement therapy (NRT) and information on how to quit. However, an apparent lack of funding for NRT is one issue raised by the NSWNA.

‘We are concerned that other services may be cut in order to pay for NRT, which raises the issue of nursing workloads and safety,’ said Assistant General Secretary Judith Kiejda.

‘The NSWNA fully supports providing staff with NRT training and offering NRT to patients who smoke – our concerns lie in the funding of such training and the implementation process,’ Judith said.

The NSWNA has received mixed responses to the ban, with some nurses unsure whether the benefits will outweigh the risks.

‘I agree with this policy in principle, although it is impractical for the severely and chronically mentally ill – the negative outcomes are far exceed the positive outcomes,’ said Peter Quist, a clinical nurse specialist at Morisset Hospital, where the ban is already in place.

‘We have witnessed an increase in threats of violence and aggression towards staff and other patients – I am beginning to feel like the smoke police and it is even harder with some patients who don’t understand the ban,’ Peter said.

Peter was happy to see one patient quit smoking when offered NRT, but this was one patient out of 28.

‘We are seeing patients sneak off to smoke or even smoking in their rooms – lighters and matches are being snuck into the unit and as a result the fire risk has increased exponentially,’ he said.

Maureen Bunt, RN, works at Richmond Clinic in Lismore where mental health patients are still exempt from the ban. ‘At this stage I think the concept is there but not necessarily the strategies and support to see the policy through,’ she said.

‘In mental health units, patients are going through a lot of stress. Making them stop will be difficult as it is the process and ritual of smoking as much as their addiction that needs to be broken.

‘This has to be a work in progress – the right answer will not come quickly and everyone needs to provide input and be open to ongoing tweaking and changing.’

Jeff Hardcastle, a nurse practitioner at Coffs Harbour Base Hospital, believes the positives will outweigh the negatives if a total ban is introduced at his workplace.

‘Ceasing smoking will allow for better efficiency of the patients’ medication and will be better for them economically,’ Jeff said.

‘Most of our patients smoke a pack a day which really cuts into their pension. A smoking ban will encourage them to better look after themselves and hopefully improve aspects of their health such as their teeth and recurring chest infections,’ he said.

While Jeff agrees that this is the best plan for patients long-term, he believes there will be initial problems implementing such changes. ‘Stress levels are likely to increase and the ban could pose a threat of violence,’ he said.