Tabagism and its management in Italian Psychiatric Intensive Care General Hospital Units

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Aim. The aim of this paper was to survey the current management of the problem of smoking in our Mental Health Units, the structural characteristics of the units and how a total smoking ban would be perceived by doctors and nurses. Method. An 18 items survey about smoking habits of inpatients and department inner regulations was sent to the Head Physician and the Charge Nurse of all the Intensive Psychiatric Care General Hospital Units in Italy (228 units), in order to increase the answer rate and to investigate if the perception of the problem is eventually different between the two groups. Results. We collected 65 answers from Head Physician and 79 from Nurses. Both groups think that the smoking rates for inpatients are between 50-100%. Most of the units is locked, with or without an external space, so that a total smoking ban is considered difficult to achieve by both groups. A very high rate of units has no specific rooms for smokers. In most cases the issue management is solved by a self-regulation, based on collecting cigarettes and lighters and granting a limited number of cigarettes per day. Anyway, an institutional intervention would be appreciated especially by nurses, who seem to be even more involved in the issue management and both of groups seem to badly judge the lack of sources to face the eventual ban: particularly the possibility to offer nicotine replacement therapy, a cognitive-behavioural support and providing more staff education would all be considered useful to implement the success rate of the ban. By the way, both of groups seem skeptical about the possibility of a total smoking-free policy in Acute Psychiatric Hospital Units. Though, a difference in the problem's perception between the two groups has been noticed. Discussion. Smoking cessation remains a neglected area in psychiatry, in part due to misconceptions about smoking in the mentally ill, i.e. the idea that smoking cessation will exacerbate mental illness, aggression and suicide risk, even though these believes are not supported by evidence; in part due to the lack of institutional intervention and the structural deficiencies of the units.

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