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No Smoking Linked With Decreased Violence?

S u m m a r y :
A smoke-free policy introduced in a psychiatric hospital accounts for a drop in physical assaults, suggests a new study published in the journal The Lancet Psychiatry.

Smoke-free zone breeds No Violence

Following the implementation of a no-smoking policy at the South London and Maudsley NHS Foundation Trust (SLaM), acts of violence like physical assaults decreased considerably, indicates the new findings generated by a team of researchers from New King’s College London, SLaM, University of Nottingham, and University of York; it is to be noted that the violent acts were documented both between patients and towards staff.

Smoking, the norm in mental health institutions

Smoking in psychiatric hospitals is nothing new—it has, actually, been regarded as the norm in this type of settings. Previous studies have even associated it with the early deaths of patients with mental health conditions. However, the practice remained because it was thought that its ban would lead to an increase in physical violence. The new study begs to differ.

Helping patients to quit

SLaM, on the other hand, decided to go against the tide, and implemented prohibitions of smoking on the premises of its four south London hospitals. The patients who would smoke received assistance in giving up the bad habit: for instance, they were offered nicotine replacement therapy (NRT), and they also had the choice of using e-cigarettes instead. Thereafter, a year later, the researchers analysed reports of physical assaults at SLaM, and compared this data with the information they had gathered 30 months prior to its implementation.

39% decrease in violence

The results show a 39% monthly decrease in the number of violent acts after the policy was applied, thus proving wrong the initial assumption that smoke-free zones would lead to more violence. Study author Debbie Robson, therefore, hopes that their new findings will reassure staff of these institutions.

Changing interactions

What is the link between no smoking and decreased violence? Robson explains that rates of violence decreased because the interaction between patients and staff changed: when they used to smoke (as cigarettes were considered a tool for the management of the behaviour of patients), they would often pressure their peers to give them cigarettes, which would lead to violence. On the other hand, the smoke-free policy at SLaM came with new treatment strategies for smokers, and the staff were also trained to accommodate for the change, thereby leading to a change in the culture of the ways staff and patients communicated.

Why the initial misinterpretation?

Mary Yates from the South London and Maudsley NHS Foundation Trust explains why no smoking was previously feared to potentially increase violence: according to her, tobacco withdrawal symptoms, including irritability and restlessness, were mistakenly thought to add to the burden on mental health patients. Then, when smokers would take to smoking again during the withdrawal period, they would look calmer and less irritable, which further fuelled the misinterpretation—it would, thus, be concluded that smoking might be “therapeutic and necessary” to prevent the patients from being turbulent.

It is to be noted that the study constitutes important implications for the implementation of similar policies in psychiatric hospitals as well as in institutions like prisons.


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