Innovative Ways to Support Smokers Requiring Nicotine Management in Mental Health Organisation

A partnership approach to supporting patients to stop smoking in a Mental Health setting


Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) provide mental health, learning disability and eating disorder services in County Durham, Darlington, Tees Valley, York and most of North Yorkshire. The Trust went smoke free in March 2016 and a recent audit of 2016/17 has identified smoking rates have reduced from 42.5% to 28%. The Trust looked for innovative ways to support smoking cessation, one of these being the offer of free e-cigarettes on admission to hospital for service users requiring nicotine management. Since going smoke free, over 1,000 free e-cigarettes have been issued to service users on admission to the Trust.

The Case for Change

People with mental health conditions die on average 10-20 years earlier than the general population and smoking is the single largest factor accounting for this difference. “While smoking rates amongst the general population have fallen dramatically in the past few decades they have remained stubbornly high amongst people with mental health conditions”. (The Stolen Years ASH – 2016)

In November 2013 NICE published Guidance PH48 identifying the requirement for all Trusts to go completely smoke free in both buildings and grounds. Following consultation with senior partners a conference was arranged to identify the priorities to enable the Trust to successfully go smoke free. This allowed for the opportunity to network with other Trusts and agencies to share good practice and examine any concerns both service users and staff may have.

A Trust audit performed in 2015/16, identified 42.5% of the inpatient population were recorded as smokers. This led the Trust to implement a smoke free policy to enable service users to access dedicated support including the offer of nicotine replacement therapies and e-cigarettes.

Staff training was identified as a priority to ensure brief intervention in smoking cessation was available on admission for service users whilst ensuring evidence based advice and support was provided.

Overview of Innovation

The main aims of the Trust were to protect the health of service users and to promote a healthy working environment for staff. Smoking cessation support was identified as a priority and clear objectives for a smoke free policy in each hospital setting were created. In partnership with Public Health England (PHE), the Clinical Network and North East Together, TEWV aimed to support the reduction in years lost by going completely smoke free in all hospital buildings and grounds by the provision of dedicated nicotine management and smoking cessation support to service users.

Key objectives identified by the Trust included:

  • All buildings and grounds to become smoke free
  • Supporting service users and staff reduction in smoking rates to improve health
  • Reducing second-hand smoke exposure
  • Increasing staff knowledge related to smoking and its effects on health
  • Reviewing all smoking cessation/nicotine management aids
  • Reviewing and updating the current smoke free policy and literature
  • Having service users and carers to support the project
  • Developing detailed communication plans
  • Challenging myths and providing latest evidence to support smoking cessation in mental health services

One of the innovations introduced was the offer of free e-cigarettes on admission to hospital for service users requiring nicotine management.

Progress to Date

An internal Trust review against the NICE PH48 Guidance was conducted in 2015 and demonstrated the need to implement guidance. A Project Lead was identified and a Nicotine Management and Smoking Cessation Steering Group and sub groups were all set up to support the delivery of the NICE Guidance.

The Trust went smoke free on 9th March 2016, supporting service users with nicotine management during their inpatient stay.

1500 staff received training in Very Brief Advice and nicotine replacement therapy (NRT) was made readily available. Funding was allocated internally to make free E-cigarettes available in all ward areas; over 1000 of which were dispensed in the first 9 months of the project.

TEWV has received support from Public Health England, NHS England, FRESH Regional Tobacco and local commissioners in the implementation of this policy. Work is now underway to roll out the smoke free agenda to all TEWV community services and staff.


Although TEWV successfully went smoke free in all buildings and grounds in March 2016 there were many challenges along the way with staff proving the biggest barrier.

Significant reductions in smoking rates for both staff and service users were identified in a recent Trust audit 2016/17. Audit findings include:

  • In-patient smoking rates have reduced across the Trust from 42.5% (2015/16) to 28% (2016/17)
  • All specialities have seen a reduction in smoking rates
  • 98% of patients were offered a brief intervention on admission; of those who accepted a referral, 95% had a full assessment completed
  • 95% were offered Homely Remedies (patches and Inhalator) on admission
  • 80% were offered NRT/E-cigs within 30-60 minutes of admission
  • 10% of identified smokers wish to remain smoke free on discharge
  • The largest reduction in smoking rates was within the Forensic services

The Friends & Family test identified 10% of staff as smokers in 2015; by 2016 this figure had reduced to only 8%. Many staff attributed stopping smoking to the implementation of the Trust smoke free policy.

Next Steps and Plans for the Future

One of the main challenges post-implementation was where staff continued to facilitate smoking. The policy stated that all tobacco and related items would be contraband and removed until final discharge. Staff found this aspect of the policy difficult and often returned cigarettes to service users enabling them continue to smoke throughout the day. Additional guidance and further training is now available to challenge this practice. It is too early to fully measure the quantifiable success of this change. An evaluation project, conducted by FUSE, (North East Centre for Translational Research in Public Health) along with the PHE Knowledge and Intelligence Team, is ongoing.


Lesley Colley; Tees, Esk and Wear Valleys NHS Foundation Trust

Lynda Tench; Tees, Esk and Wear Valleys NHS Foundation Trust

Sue Hart; Respiratory Programme Lead, AHSN NENC

With special thanks to Angus Bell and Suzanne Charing for their extensive support with this project.

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