Vaping Reducing Violence in Mental Health Settings

Posted 7th July 2017 by Mawsley
A paper published in Lancet Psychiatry claims that banning smoking and only encouraging traditional nicotine replacement therapies has led to a decrease in patients committing physical violence. It also highlights a distinctly odd approach to vaping being taken by the South London and Maudsley (SLaM) National Health Service Foundation Trust.

“Staff working in psychiatric services are often exposed to violence during the course of their work.” write the team in their paper. “Findings from a meta-analysis of 35 studies, including 23972 inpatients, showed that 17% of inpatients committed at least one violent act during a hospital admission.”

They continue: “In 2014–15, there were 45220 physical assaults against UK National Health Service (NHS) staff working in psychiatric settings (187 assaults per 1000 staff), compared with 19 167 assaults in general acute settings (21 per 1000 staff). The adverse effects of violence include injury, fear, low morale, stress, and staff absence.”

Clearly, this presents a problem – and one that could have escalated when the smoking ban was introduced. According to Debbie Robson, as well as being a instrument of addiction to be combatted, “Cigarettes have traditionally been used as a tool to motivate patients to do things like get out of bed in the morning, take their medication or go to group. They have been an important currency on the ward between patients and patients and patients and staff.”

Patients were offered traditional quit products and disposable ecigs as an alternative, but (curiously) patients were expected to purchase their own vaping device. The team claim there was a 39% reduction in the number of physical assaults per month as a result of the no-smoking policy, and just 4.9% of incidents were smoking related.

What is SLaM’s approach to vaping?

SLaM’s advice on quitting: “What is the most effective way to stop smoking? The Department of Health recommends a combination of intensive behavioural and psychological support alongside medication to minimise nicotine withdrawal symptoms and help with cravings. Effective medication includes Nicotine Replacement Therapy (NRT), bupropion and varenicline.”

The support given by the Trust to vaping can best be described as lukewarm: “Can patients use e-cigarettes on Trust sites? E-cigarettes can be purchased by patients or brought into services by visitors. Patients should only use disposable e-cigarettes in designated and discrete areas such as hospital grounds and single bedrooms. They should not be used in communal indoor areas, ward gardens or any other places where patients or staff congregate.”

The stance reflects an odd sense of priorities, laid out in the SLaM Smokefree Policy: “Focus group discussions have indicated that there is a desire among some patients and staff to use e-cigarettes to support cutting down or quitting tobacco. It is critically important that e-cigarettes do not simply replace cigarettes so that a culture of e-cigarettes replaces the smoking culture.”

While any increase in peace on mental health wards is to be welcomed, an obvious question is how much further would the drop in violence have been had patients been allowed unrestricted access to a product 95% safer than smoking?

The full study available by subscription here: http://dx.doi.org/10.1016/S2215-0366(17)30209-2