Smoking rates among people with mental health problems (70-90%) is much higher than in the general community (20-23%), yet traditionally mental health inpatient services have provided little in the way of smoking cessation care.

Discussion:

The recent introduction of a Smoke Free Workplace Policy within Hunter New England Area Health Service has served as an impetus for the development of best practice guidelines for smoking cessation care for mental health patients who smoke. Strategies have included the establishment of advisory committees and the identification of key supportive people to promote the change in policy. A survey was also developed to assist in identifying the attitudes, knowledge and skills of staff prior to the introduction of the Policy.

Conclusion:

Since the successful implementation of the Smoke Free Workplace Policy some staff attitudes to enforcement have remained a barrier, such as the cost in terms of effect on therapeutic alliance is too high. The need to support staff in enforcing the policy amongst themselves, consumers, and visitors remains an ongoing concern. The ethical debate between peoples' right to clean air versus peoples' perceived right to smoke continues, along with the belief that tobacco use is a lesser concern for those in a mental health facility. The change in culture for mental health clinicians to view tobacco cessation as part of their core business is one of the continuing challenges faced, despite evidence that a majority of staff support the introduction of the Smoke Free Policy in their workplace.