Academic journal article Advances in Mental Health

A Mountain Not Too High to Climb: A Qualitative Study Exploring Facilitators and Barriers to Smoking Cessation in a Regional Mental Health Service

Academic journal article Advances in Mental Health

A Mountain Not Too High to Climb: A Qualitative Study Exploring Facilitators and Barriers to Smoking Cessation in a Regional Mental Health Service

Article excerpt


Tobacco smoking is the largest single preventable cause of death and disease in Australia (Lim et al., 2013; Öberg, Jaakkola, Woodward, Peruga, & Prüss-Ustün, 2011) and is a serious and problematic issue in mental health. While smoking prevalence in Australia has declined markedly in recent years (Australian Bureau of Statistics, 2012), reports suggest that up to 88% of people who have mental health problems of any kind continue to smoke (Lawn & Pols, 2005).

An official government health department smoke-free policy has been in force in Queensland, Australia, since 2006. Although the policy applies equally to general hospital facilities and mental health inpatient facilities, many mental health units have been reluctant to fully enforce the policy and have failed to successfully implement smoking bans (Campion et al., 2008). Concerns that the restrictions may place additional pressures on vulnerable consumers and exacerbate their distress are frequently cited for the failure to implement the policy, with stafffearing increased aggression and violence (Wye et al., 2010). However, Campion et al. (2008) suggested that staffattributions that disturbed behaviour will occur due to the enforcement of smoking bans are not supported by the data. Indeed, predictors of failure to implement smoking bans in inpatient mental health facilities are more likely to be inconsistent application of the bans and high levels of staffsmoking (Campion et al., 2008; Lawn & Campion, 2010).

Some instances of successful experiences of services moving to non-smoking status have been reported and these cases show that smoke-free policies can be successfully implemented within mental health inpatient units (Lawn & Campion, 2013;Wye et al., 2010;Wye et al., 2014).

In an acute mental health service on the Sunshine Coast, Queensland, Australia, an attempt to implement the state government smoke-free policy in 2008 led to staffupheaval and ultimately a refusal to enforce the smoking ban. At this time, clinicians, consumers and carers were interviewed about their experiences of the process. This information was used to develop and refine a new approach to smoking cessation that was implemented in 2013.

This intervention involved a staged approach over approximately 12 months and comprised preparatory, developmental and pre-implementation phases prior to the actual implementation. In the preparatory phase, a working party was formed and management and reporting structures were established. In the developmental phase, communication and implementation strategies were devised. Some strategies addressed engagement with, and training for a range of stakeholders while others concerned assessment and monitoring of nicotine use, processes for reporting breeches, and progress review and subsequent adjustment of the process (if deemed necessary). The preimplementation phase continued with the communication and promotion of the programme and finalised documentation regarding management practices and staffprocedures; additionally, smoking paraphernalia were removed and existing designated smoking areas were decommissioned. Table 1 outlines the strategies that were implemented and the outcomes achieved.

This approach proved much more successful than the first attempt. This qualitative study explored the facilitators and barriers to the adoption and implementation of the smoke-free policy in this acute mental health service in Queensland, Australia. The research question was "What are the factors that may contribute to (facilitators) or hinder (barriers) the successful implementation of smoke-free policies in acute mental health services".


The study was conducted in an acute mental health service in the Sunshine Coast, Queensland, Australia.

Participants and data collection

In 2014, one year after the implementation of a smoking-free policy, structured interviews were conducted with 10 participants: 6 clinicians, 2 lead clinicians and 2 consumers ("consumers" is the preferred terminology employed by the service to describe clients). …

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