Tobacco dependence, treatment and smoke-free policies: a survey of mental health professionals' knowledge and attitudes

Elena Ratschen, John Britton, Gillian A Doody, Jo Leonardi-Bee, Ann McNeill
General Hospital Psychiatry 2009, 31 (6): 576-82

BACKGROUND: Mental health inpatient units in England have to be smoke-free by law. Preliminary studies have indicated that staff may not have the necessary knowledge and resources to support the implementation of a smoke-free policy.

OBJECTIVE: The objective of this study was to investigate staff knowledge and attitudes relating to smoking prevalence, dependence, treatment and the relationship between smoking and mental illness.

DESIGN: This study used a questionnaire survey for all the clinical staff of 25 inpatient mental health units of a UK National Health Service mental health Trust.

RESULTS: Four hundred fifty-nine (68%) staff returned the questionnaire. Less than half (42%) of the participants agreed that dealing with patients' smoking was their responsibility as a mental health professional, and only half (50%) asserted that they could make time to treat smoking in their working routine. All professional groups demonstrated a lack of knowledge about tobacco dependence, treatment and its relation with mental illness, with healthcare assistants being least knowledgeable overall. Nevertheless, 41% of doctors were unaware that smoking can decrease blood levels of antipsychotic medications, and 36% were unaware that stopping smoking could reduce the dose needed. Staff overestimated the prevalence of smoking in the general population, and over a third (36.4%) believed that nicotine was carcinogenic. Staff smoking prevalence was 26% (10% of doctors, 22% of other qualified staff and 37% of nonqualified staff), and smokers were more likely to have reservations about the importance of the smoke-free policy and the treatment of nicotine dependence among patients. Reported participation in training was associated with greater knowledge related to some items of the questionnaire.

CONCLUSIONS: Support for inpatient smokers by staff is likely to be severely compromised by low levels of knowledge and awareness of tobacco dependence. Further training and support for all staff groups are urgently required.

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