Background: Smoking tobacco via cigarettes, is the leading cause of preventable deaths in New Zealand and second-hand smoke is associated with many of the same cancers and diseases. Throughout New Zealand, District Health Boards are implementing strategies to prevent in-patients from exposure to tobacco smoke. Frequently exemptions are made for mental health inpatient service users: a group that experiences considerable health inequalities.

Discussion: This is of particular interest because tobacco plays an integral part of the in-patient socialisation process and has historically been allocated place in the internal and external environment of the in-patient service. It finds place as part of the economic arrangements, as a core need, as systemic exposure, tolerance of harm, as a multifunctional tool, in exchange and barter and as physical space. These elements of place are institutionalised and provide a foothold for strong resistance to the implementation of smoke free policies.

Conclusion:

An understanding of the way in which tobacco finds place in the mental health inpatient setting is essential for understanding staff, patient and policy-maker resistance to change and for the develop of smoke free policy. We must look backwards into the future.