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Patient violence drops after psychiatric hospitals go smoke-free

South London and Maudsley NHS Foundation Trust reports a 39% reduction in the number of physical assaults after prohibiting smoking in the buildings and grounds of its hospitals.
No smoking

Research has revealed a 39% drop in violence following the introduction of a smoke-free policy at a London psychiatric hospital.

In 2014, South London and Maudsley NHS Foundation Trust (SLaM) introduced a policy prohibiting smoking in the buildings and grounds of its four south London hospitals.

Smokers are offered support to quit smoking, such as nicotine replacement therapy, and patients are allowed to use e-cigarettes at the sites.

Savings

The trust estimates it has since saved more than 1.5 million per year by cutting the amount of time band 5 nurses spent supervising patients cigarette breaks.

Researchers from Kings College London, SLaM, University of Nottingham and University of York, analysed incident reports of physical assaults 30 months

Research has revealed a 39% drop in violence following the introduction of a smoke-free policy at a London psychiatric hospital.


Introducing a smoke-free policy across the trust did not lead to an increase in physical violence, as it sometimes feared, researchers said. Picture: Alamy

In 2014, South London and Maudsley NHS Foundation Trust (SLaM) introduced a policy prohibiting smoking in the buildings and grounds of its four south London hospitals.

Smokers are offered support to quit smoking, such as nicotine replacement therapy, and patients are allowed to use e-cigarettes at the sites.

Savings

The trust estimates it has since saved more than £1.5 million per year by cutting the amount of time band 5 nurses spent supervising patients’ cigarette breaks.

Researchers from King’s College London, SLaM, University of Nottingham and University of York, analysed incident reports of physical assaults 30 months before and 12 months after the smoke-free policy was introduced. 

The study, published in The Lancet Psychiatry, showed there were 4,550 physical assaults during the research period, with 2,916 towards staff and 1,634 between patients.

Researchers found a 39% reduction in the number of physical assaults per month both between patients and towards staff following the introduction of the policy.

Managing behaviour

King’s College London senior post-doctoral researcher in tobacco Debbie Robson said: ‘Hopefully our findings will reassure staff that introducing a smoke-free policy does not increase physical violence, as is often feared.

‘We believe there are a number of possibilities why rates of violence actually decreased. Historically, cigarettes have been used as a tool to manage patient behaviour and patients often coerce their peers into handing over cigarettes.

‘To support the introduction of the smoke-free policy SLaM invested in new treatment pathways for smokers and a staff training programme, which may have contributed to changing the culture of how staff and patients interact.’ 

SLaM nurse consultant and smoke-free lead Mary Yates added: ‘Tobacco withdrawal often prompts restlessness, irritability and a fixation on finding opportunities to smoke, and hospital staff understandably mistake this as a sign of worsening mental health.

‘Smoking during a period of tobacco withdrawal only serves to reinforce this misinterpretation, as patients will appear calmer and less irritable as nicotine levels are topped up. This is incorrectly taken as evidence that smoking is therapeutic and necessary to prevent agitation.’


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