Implementation of a smoke-free Psychiatric Unit in a general hospital

Implantação de Unidade Psiquiátrica livre de tabaco em um hospital geral

CARTAS AOS EDITORES

Implementation of a smoke-free Psychiatric Unit in a general hospital

Implantação de Unidade Psiquiátrica livre de tabaco em um hospital geral

Dear Editor,

Smoking is more prevalent among patients with severe mental disorders than in the general population. Moreover, other health threatening factors, such as obesity, sedentary lifestyle, and less attention to general health and self-care, contribute to increase the morbidity and early mortality in this population.¹

The relationship between psychopathology and smoking (self-reported cognitive improvement, decrease in antipsychotic side-effects, and anxiety),² together with restrictions on the use of some medications and behavioral strategies, are some of the difficulties in the nicotine dependence treatment for these patients. Currently, nicotine replacement therapy (NRT) has been considered to be the most effective and safest option to aid smoking cessation in this population.³

The Hospital das Clínicas da Universidade Estadual de Campinas (HC-UNICAMP) has 3,100 employees and 394 beds. It is a reference institution in health care, teaching, and research, and therefore it has an exemplary role in providing high-standard care and environment. Its 12-bed Psychiatric Unit (PU) admits patients suffering from mood disorders (34%), psychotic disorders and schizophrenia (28%), personality disorders (12%), organic mental disorders (9%), and disorders related to the use of psychoactive substances (7%).⁴

In the beginning of 2008, a multisectoral committee was created in order to implement measures to make the hospital 100% free from tobacco. One of the main obstacles to achieve that goal was the fact that the fourth floor of the building, where the PU is located, used to be regarded by both patients and professionals as a smoking area. Table 1 describes the main measures taken to ban smoking in the hospital.

Between June 2008 and May 2009, 196 patients were hospitalized at the PU, 26% of whom were smokers. On average, they were 37 years old and had been smoking 22 cigarettes per day for the last 19 years. Twelve months after hospital discharge, all patients were contacted by telephone and interviewed: 31% maintained the same smoking pattern, 27% reduced the number of cigarettes smoked per day, 10% had quit smoking but relapsed, and 27% had quit smoking completely since the time they were hospitalized.

The two main difficulties identified in the smoke-free program were the resistance of hospital employees to acknowledge that the fourth floor was no longer a place for smoking, and the lack of NRT for all the hospital wards. Overall, the implementation of the program was smoother than initially expected. There were neither increased reports of aggressive behavior nor admission refusals. The old "negotiations" between staff and patients, who used cigarettes as an exchange currency, have been replaced by walking at the hospital yard, dominoes matches, and listening to the piano available on the fourth floor. Some hospital professionals also stopped smoking.

The comment made by an interviewed patient reinforces the importance of the initiative and encourages other services to do the same: "I thought it's all right [not being allowed to smoke in the hospital] because I started smoking inside a psychiatric hospital. At that time, I was admitted with one disease and discharged with two! For those admitted today, this no longer happens".

Renata Cruz Soares de Azevedo, José Luiz Risi Leme, Fabrício Zacche Miranda, Neury José Botega

Department of Medical Psychology and Psychiatry, Faculdade

de Ciências Médicas, Universidade Estadual de Campinas

(UNICAMP), Campinas, SP, Brazil

Celina Matiko Hori Higa

Psychiatric ambulatory, Hospital das Clínicas, Universidade

Estadual de Campinas (UNICAMP), Campinas, SP, Brazil

^{Clique para ampliar}

• 1. Jochelson K. Smoke-free legislation and mental health units: the challenges ahead. Br J Psychiatry 2006;89:479-80.
• 2. Hennekens CH, Hennekens AR, Hollar D, Casey DE. Schizophrenia and increased risks of cardiovascular disease. Am Heart J 2005;150(6):1115-21.
• 3. Lawn S, Pols R. Smoking bans in psychiatric inpatient settings? A review of the research. Aust N Z J Psychiatry 2005;39(10):866-85.
• 4. Dalgalarrondo P, Banzato CE, Botega NJ. Psychiatric admissions in a Brazilian general hospital: a review of outcomes. Gen Hosp Psychiatry 2003;25(2):139-40.

Publication Dates

• Publication in this collection
  16 July 2010
• Date of issue
  June 2010