Title: Treating smoking in mental health inpatient settings – exploring options to implement new NICE guidance
Funder: Cancer Research UK

Abstract: Background Smoking, though decreasing in the general population, is still deeply embedded into the culture of many mental health settings and despite the impolementation of smokefree policies, remains the norm in many mental health Trust. Smoking breaks are usually facilitated for patients on a regular and frequent basis using valuable staff time, and opportunities to support patients who wish to stop smoking or require nicotine replacement therapy and behavioural support to deal with temporary abstinence are often missed. New NICE guidance advocating comprehensive treatment pathways for patients who smoke in the context of strictly enforced smokefree policies that do not any longer allow for exemptions, presents a chance and a challenge for mental health Trusts to integrate the treatment and management of smoking, in the context of cessation and temporary abstinence, into patient treatment pathways. Aims To assess current practice relating to treating and facilitating smoking, and managing abstinence from tobacco (including cost estimates for staff resources spent on facilitating smoking breaks; to develop comprehensive tobacco dependence treatment and management pathways with staff, adhering to a strict complete smoking ban, with clinical staff; to compare smoking related outcomes (cessation; reduction; abstinence; nicotine withdrawal; recorded smoking related incidents;) and other relevant measures (patient, visitor and staff feedback) on two acute mental health inpatient wards. Methods A mixed-methods study design will be employed. Current practice relating to recording and treating/managing smoking will be reviewed using case note audit; resources spent facilitating smoking breaks will be assessed through structured observation. Qualitative focus groups/workshops with staff will form the basis for the development of adequate tobacco dependence treatment/management pathways. In a controlled before-and-after pilot study, smoking related and other relevant outcomes will be measured on an intervention and a control ward (where current practice is not changed), at three time points before and after implementing the intervention respectively. Outcome measures comprise: smoking status; heaviness of dependence (HSI); nicotine withdrawal (MNWS); motivation and self-efficacy to quit (visual analogue scale); number of prescribed and used pharmacotherapy; reduction of dosage of antipsychotic medication following tobacco abstinence; smoking-related recorded incidents (verbal and physical); fire incidents; patient satisfaction with treatment and care experience; measures of staff smoking and staff attitudes towards smokefree environment and treatment of tobacco dependence; feedback from patients, visitors and staff. How the results of this research will be used To develop recommendations for the implementation of new NICE guidance in mental health Trusts


Research activity codes: 3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: CANCER AND NEOPLASMS