Smoke-free psychiatric hospitals: a platform to initiate smoking cessation treatment

Persons with a mental disorder smoke at higher rates and suffer disproportionate tobacco-related morbidity and mortality than the general population. Targeted, intensive cessation treatment may be required to reduce the tobacco-related burden experienced by this group. A smoke-free psychiatric hospitalisation - where nicotine withdrawal can be managed in the absence of environmental cues to smoke - has been identified as an opportunity to address smoking among persons with a mental disorder. The broad aim of this thesis was to explore smoke-free psychiatric inpatient settings as a platform to initiate smoking cessation treatment, and to test the efficacy of linking hospital-based to community-based smoking cessation treatment in reducing tobacco consumption among persons with a mental disorder. The studies comprising the chapters of this thesis aimed to: 1) determine the impact of admission to a smoke-free psychiatric facility on patients’ smoking-related behaviours, motivations and beliefs; 2) examine the quality of implementation of a smoke-free policy in an Australian inpatient psychiatric facility, including patients’ self-reported adherence to the smoking ban; their perception of staff support for the smoke-free policy; their receipt of nicotine dependence treatment; and their acceptability of the smoke-free policy; 3) examine the smoking-related characteristics of patients admitted to an inpatient psychiatric facility with a smoke-free policy in Australia, including their readiness to quit smoking, previous quitting behaviours, and factors associated with readiness to quit; and 4) determine the efficacy of a smoking cessation intervention initiated during a smoke-free psychiatric hospitalisation and continued post-discharge in reducing tobacco consumption among smokers with a mental disorder.