Smoking in an Inpatient Psychiatric Unit in Ireland with a “Tobacco Free Campus” policy: the prevalence, the associated factors, the social consequences and what can be done to address this
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Adult Acute Mental Health Unit, Galway University Hospital, Galway, Ireland
School of Medicine, University of Galway, Co. Galway, Ireland
Karthika Srikumar   

Adult Acute Mental Health Unit, Galway University Hospital, Galway, Ireland
Publication date: 2023-04-25
Tob. Prev. Cessation 2023;9(Supplement):A103
Smoking is highly prevalent in patients with mental health disorders and although most literature describes it’s impact on physical health, there is little to address the social consequences associated with nicotine addiction. In 2022, Ireland's Health Service Executive (HSE) published clinical guidelines, regarding smoking cessation in secondary mental health service users, in response to this ongoing issue.

Material and Methods:
We performed a cross-sectional analysis of all patients admitted to the inpatient psychiatric unit on a single date. The patients were interviewed using a standardised format. Case records and medication charts were also examined. We analysed this data using Microsoft Excel, which allowed us to assess any changes in smoking behaviour and how this was managed, if at all.

Of the 51 inpatients, 78% (n=40) had an Axis 1 diagnosis according to the DSM-4, 72% (n=37) were unemployed and 67% (n=34) were receiving Social Welfare. 57% (n=29) of inpatients were current smokers. 63% (n=25) of smokers had an Axis 1 diagnosis, 51% (n=19) were unemployed and 53% (n=18) were receiving Social Welfare. Since admission, 52% (n=15) of smokers have been smoking more, and 48% (n=14) have been spending more money on tobacco. 7% of smokers (n=2) started smoking on the unit. 50% (n=9) of smokers receiving Social Welfare were smoking more, with the majority of them on long-term disability allowance (n=7). 10% (n=3) of smokers were prescribed NRT, with only 1 patient taking NRT. 90% (n=26) of smokers did not have smoking addressed in their care plan. 38% (n=11) had a fully completed smoking history in the nursing admission, while only 14% (n=4) had one in the medical admission.

Despite the Tobacco Free Campus policy, smoking continues to be highly prevalent in an inpatient psychiatric setting. A large proportion increased their smoking on admission, and their expenditure on tobacco. We also now have inpatient health services where a number of patients have started to smoke since admission, despite policies in place. More needs to be done to address this issue, including early identification of smokers, prescribing NRT when appropriate, and thus empowering patients to make positive choices for their physical health and financial wellbeing.

This poster has been accepted to be presented in the European Psychiatric Association Congress in March 2023.