Grampian Mental Health Services Tobacco and Smoking Cessation

1. Grampian Mental Health ServicesTobacco and Smoking Cessation Lyn Irvine-Brinklow Smoking Cessation Specialist (Mental Health)

2. Introduction • Many mental health hospitals in Scotland have already made considerable progress towards making their indoor premises smoke free, and have introduced policies which permit smoking in their grounds only or in designated shelters within their grounds. • Smokers have retained a choice about whether to smoke, but the hospital or ward policy has set out where and when this is permitted.

3. Reasons for going smoke free • Staff do not wish to be subjected to passive smoking and the associated harmful; impacts on their physical health. • People with mental health problems should not be treated in a different way to other members of the public in terms of looking after their physical health.

4. So far Development of Smoking Cessation Specialist Mental Health (2006) 3 main objectives of the post: • To provide specialist smoking cessation support to individuals and groups of people who have severe and enduring mental health problems. • Responsibility for developing, organising and delivery of training in relation to mental health issues and smoking to a wide range of mental health professionals in order that they in turn will be equipped to promote smoking cessation. • Lead role in promoting and challenging a culture change in conjunction with legislation and policy change.

5. Development of Smoking Cessation Advisor, Mental Health Staff (2008) To provide smoking cessation support to staff working within GMHS and Learning Disability Services. To promote a culture change in conjunction with legislation and policy change.

6. Smoke Free Support Group Purpose of group This group exists to provide help and support to wards that are interested in moving to a smoke free indoors environment, through acting as a forum for discussion and problem solving. Where staff working in areas where there is still smoking have an opportunity to engage in a structured but informal way with staff from areas which have already achieved smoke free indoor status.

7. Grampian Mental Health Services Smoking Cessation Overview Steering Group Purpose of group The group exists to provide a forum for discussion and problem solving relating to all aspects of smoking and tobacco within Grampian Mental Health and Learning Disability Services.

8. Current Status: Clinical Areas Smoke Free • Old Age Psychiatry Directorate. Smoke FreeIndoors (smoking permitted in garden area). • Great Western Lodge (forensic community rehab unit). • Eden Unit (Eating Disorders Unit). • Blair Unit – Forensic Acute, Forensic Rehab and Intensive Psychiatric Care Unit). Smoking Rooms • Adult Directorate (4 wards). • Learning Disability Directorate (2 wards and one day hospital). • Ward 4, Dr Grays (1 ward). • Specialism’s Directorate (2wards and 1 community rehab unit).

9. Conceptual and Instrumental Impact • Provision of specific training ‘Raising the Issue of smoking with mental health service users. • As of the 1st October tobacco and tobacco products were no longer available to purchase at the WRVS, Clerkseat building, RCH. This has been implemented with very few issues arising. • Recent production of a briefing paper to remind all staff to ‘lead by example’ and ensure Line Managers proactively and publicly support the enforcement of the Tobacco Policy 2006.

10. Regular informal smoking cessation advice and information sessions held for staff, patients, service users, visitors and carers to find out about the Smoking Cessation Specialist Service, the SAS and pharmacy schemes. • Presentations at staff meetings and ward forums. • Smoking cessation as part of on-going education programme within community rehab setting.

11. The Plan • Commitment to making cessation support readily available to patients and staff who wish to change their smoking habits. • Staff allowed to negotiate time to attend support sessions. This helps to promote the message that staff are valued and that RCH is committed to a smoke-free policy. • An acknowledgement that smoke free policies are not moral judgements, they restrict where and when people can smoke rather than restricting the choice of whether to smoke or not. • Operational managers have signed up to ensuring staff attend training from their relevant directorates.

12. Challenges • Cost of provisions to become smoke free indoors such as smoking shelters and nicotine replacement therapy costs. • Clear guidance on way forward. • Release of staff for training in current climate. • Smoking culture. • Exceptional circumstances when exemptions may be necessary.