University of Otago (Wellington) Suicide and Mental Health Research Group director Dr Gabrielle Jenkin said smokers with serious mental illness should be actively supported to quit.
However, she noted the issue was a complex one, and trying to apply a blanket smoke-free policy in acute mental health units was unlikely to succeed.
Her researchers interviewed staff and service users at four acute mental health units across New Zealand and found psychiatric wards were applying smoke-free policies inconsistently or ignoring them altogether.
The staff interviewed were convinced restricting smoking would lead to an increase in aggression and assaults from service users, and a stay in an acute mental health facility was not the best time for people to give up smoking.
Mental health service users surveyed said smoking alleviated boredom and helped them feel calm in a distressing environment.
Dr Jenkin said despite commonly held beliefs that smoking had sedative and calming effects, it was not the best way of relieving stress.
It had an impact on the body’s uptake of many commonly used psychiatric medications, including olanzapine, clozapine, fluoxetine and fluvoxamine.
Instead, she said health providers needed to develop bespoke smoking cessation programmes.
The fact many service users were smoking to alleviate boredom was an ‘‘indictment’’ of acute mental health units, she said.
‘‘Acute mental health care wards should provide therapeutic environments that promote recovery, with opportunities for connection, hope and optimism, identity work, and meaningful activity, as well as being places of safety and security.’’
She said the Government’s recent pledge to invest in rebuilding and refurbishing adult acute mental health facilities meant there was an opportunity to address some of these issues.
Smoking cessation would be supported by better-designed facilities with more options for alleviating boredom, expressing autonomy, facilitating social connections and reducing distress, she said.
Her research is part of a larger three-year project, titled ‘‘Design of Acute Mental Health Wards: The New Zealand Experience’’, which examines the architectural design, therapeutic philosophy and social regime of adult acute mental health inpatient facilities in New Zealand.
