The Impact of a Smoking Cessation Policy on Visits to a Psychiatric Emergency Department

Article excerpt

Objective: Smoking cessation policies are increasingly imposed in mental health facilities because of the high prevalence of tobacco smoking and its related adverse health consequences. The objective of this study was to measure the impact of 2 smoking cessation policies-one imposed in a specific psychiatric hospital and the other across the entire province of Ontario-on weekly visit rates to a psychiatric emergency department.

Methods: Administrative data records from consecutive patient visits to a psychiatric emergency department were grouped by week from March 1, 2002, to December 31, 2005. The patients were grouped into 3 broad diagnostic categories: substance-related disorders, psychotic disorders, and other disorders. The impact of 2 smoking cessation policies-one imposed on September 21, 2005 at the Centre for Addiction and Mental Health (CAMH) and one imposed on May 31, 2006 across the province of Ontario-on psychiatric emergency department visit rates was measured using time series analysis.

Results: The CAMH-specific smoking cessation policy had no impact on psychiatric emergency department visit rates in any diagnostic category. The province-wide smoking cessation policy resulted in a 15.5% reduction in patient visits for patients with a primary diagnosis of psychotic disorder.

Conclusions: The benefits of a smoking cessation policy need to be balanced by the impact of the policy on the likelihood of patients to seek treatment.

Can J Psychiatry 2008;53(11):779-782

Clinical Implications

* Smoking is highly prevalent in patients with mental illnesses, particularly patients with psychotic and substance-related disorders.

* Smoking cessation policies imposed across a region may act as a barrier to crisis services for patients with psychotic disorders.

* The beneficial effects of a smoking cessation policy need to be balanced with the potential for these policies to act as barriers to crisis care.

Limitations

* The diagnostic categories are based on administrative diagnostic codes that have not been validated.

* The duration of observation past the smoking cessation policies is relatively brief.

* We were unable to measure regional effects of the smoking cessation policies.

Key Words: smoking cessation, psychiatric emergency department, visit rates

Abbreviations used in this article

CAMH Centre for Addiction and Mental Health

ICD-10 International Classification of Diseases-tenth revision

In the past, smoking tobacco in psychiatric and addiction treatment facilities was a widely accepted occurrence.1,2 People with mental illnesses are twice as likely as people with no mental illnesses to smoke,3 and the likelihood of smoking is even higher for patients with psychotic and (or) substance use disorders.3 Mental health treatment facilities have imposed smoking cessation policies in response to well-documented adverse health consequences associated with smoking.4-6

Reviews of smoking bans in inpatient settings suggest that adverse consequences, such as behavioural difficulties and violence, are rare with the exception of a few studies.1,2 While policy implementation may not lead to adverse consequences in inpatient settings, most studies indicate that most patients resume smoking immediately upon discharge.1,2 Further, most studies have focused on patient outcomes during hospitalization. Whether or not an inability to smoke is a deterrent to people seeking care from these institutions in the first place is unknown.

In this study, we assess the impact of 2 smoking cessation policies-one restricted to a particular institution and one affecting the entire province of Ontario-on the number of weekly visits to a psychiatric emergency department. We also assess the impact of these 2 policies on emergency department visit rates across 3 broad diagnostic categories-substance-related disorders, psychotic disorders, and other disorders. …