The objective of this work was to explore the practical implications of, and the problems arising from, the implementation of a comprehensive smoke-free policy in acute adult inpatient mental health wards.

This is a qualitative study that uses semistructured interviews with a stratified purposive sample of 16 medical and nonmedical staff of two wards in an acute mental health trust in England that had implemented a smoke-free policy in buildings and grounds in March 2007.

The smoke-free policy was viewed ambivalently and was substantially compromised by widespread use of exceptions such as permitting patients to smoke in an outdoor patio and covert indoor smoking. Smoking breaks were described to be a fixation for patients and sometimes disruptive to therapeutic activities. Nicotine dependence and withdrawal were not assessed or supported systematically. Awareness of interactions between smoking and certain antipsychotic medications was anecdotal and did not impact on clinical practice.

The implementation of smoke-free policies in these acute mental health wards suffered from the provision of regular institutionalized smoking breaks, a lack of sustained investment in staff training and a lack of comprehensive cessation or abstinence support for patients. These issues need to be addressed; otherwise, the implementation of smoke-free policies in mental health settings may result in unintended adverse effects.