Time to Smoke: Facilitating Smoking Breaks in Mental Health Inpatient Settings

Abstract

Introduction: Prevalence of smoking in mental health patients is up to three times higher than in the general population, with the highest rates seen in inpatient settings. In many countries, smoke-free policies in inpatient settings prohibit smoking in buildings but allow supervised smoking breaks. We aimed to estimate staff resources dedicated to such breaks.

Methods: A cross sectional survey was conducted with a convenience sample of inpatient mental health staff from four hospitals in London, England. Staff were asked about the number of designated supervised smoking breaks and their duration, per day, on their ward. We calculated the opportunity cost of the time allocated to supervising smoking.

Results: The survey was completed by 67 staff from 25 inpatient wards across four hospital sites. Eighteen wards had designated daily supervised smoking breaks; the average number of breaks per ward was 7.6 (SD 3.9), with an average of 2 hours, 23 minutes a day of clinical time dedicated to supervising smoking. We estimated the opportunity cost of supervising smoking was between £50 to £238 per ward per day or £18 250 to £86 870 per ward per year, depending on the seniority of staff supervising smoking breaks.

Conclusions: Considerable time and resources is being used to facilitate smoking in mental health hospitals with smoke-free policies which allow smoking in hospital grounds. This resource could be redirected to provide evidence-based care that improves health and wellbeing, such as tobacco dependence treatment.

Implications: This study is the first to estimate the time and opportunity costs of facilitating smoking across different wards in a mental health setting in the United Kingdom. Health care resources are scarce, including staff time. Every time staff facilitate smoking, clinical time is diverted away from therapeutic activities that contribute to improved patient health. Rather than suggesting any financial savings can be made through the introduction of smoke-free services, we present one metric of the value to mental health service providers of the hours of clinical time that could be released to provide therapeutic care.