ASH Mental Health Report

Posted 11th November 2019 by Dave Cross
Action on Smoking and Health (ASH UK) has produced a report looking at the NHS mental health trusts in England for Public Health England. The survey was conducted in Spring 2019 and examines whether the Government’s objective for all mental health trusts to be smokefree by 2018 has been achieved.

The report describes both the extent to which smokefree policies and support to quit smoking has been adopted and the reality of local practice in delivering these policies; it contains a section on vaping.

ASH UK discovered that:

  • 1 in 5 mental health trusts still do not have a comprehensive smokefree policy in place, despite the Government deadline for implementation having passed last year
  • Staff behaviour often enables smoking, with staff accompanying patients on smoking breaks every day in 57% of trusts
  • In 55% of trusts, patients were not always asked if they smoked on admission
  • Only 47% of trusts offered the choice of combination NRT or varenicline in line with NICE best practice
  • 9% of surveyed trusts, some or all inpatients were not permitted to vape
  • 47% of surveyed trusts allowed all types of e-cigarettes to be used
  • 31% of surveyed trusts only allowed the use of non-rechargeable, disposable devices
  • All but one trust restricted where e-cigarettes could be used
  • 44% of surveyed trusts allowed the use of e-cigarettes indoors
  • Three quarters (76%) of surveyed trusts allowed the use of e-cigarettes in ward courtyards
  • Two fifths (42%) of surveyed trusts provided e-cigarettes free to their patients

The need for a comprehensive approach that includes vaping was underlined by one patient: “I had someone start on me because of cigarettes — nothing to do with me — I was just walking past, and he was smoking in his room ... he was there suffering from psychosis, and the lack of nicotine was just making him even more wound-up.”

A problem exists even for some of the Trusts that encourage vaping. According to the patient group that was consulted, “first generation ‘cig-a-like’ e-cigarettes had been offered to them as service users but that they, along with others, had not found these products satisfying.”

They suggested they “should be able to use their own devices and access different types of e-cigarettes while in inpatient services.

SMKD

The consultation document noted: “the relative harms of e-cigarettes compared to tobacco highlighted that there is continued uncertainty around the efficacy of e-cigarettes for smoking cessation and the level of reduced-risk.”

The survey found that “there was no consensus about whether vaping should be permitted indoors.”

Twenty trusts allowed indoor vaping, mostly in bedrooms. Twenty-seven trusts had shared occupancy bedrooms as well as private bedrooms, and restricted vaping to the latter. Only three trusts allowed vaping in the hospital grounds and one only allowed vaping off-site - but sold ecigs on the ward. Five trusts had installed ‘it’s OK to vape’ signs.

Related:

  • “Progress towards smokefree mental health services”, ASH UK – [link]


 Dave Cross
Article by Dave Cross
Freelance writer, physicist, karateka, dog walker
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