Changes in voluntary admission and restraint use after a comprehensive tobacco-free policy in inpatient psychiatric health facilities

Abstract

Background: Cardiovascular and respiratory diseases, predominantly due to tobacco use, are the leading causes of death among individuals with serious and persistent mental illness. However, many psychiatric health facilities do not routinely treat tobacco use disorder. The purpose of the current study was to examine the impact of implementing a tobacco-free policy in inpatient psychiatric health facilities in a large, urban setting on behavioral problems, treatment access, and tobacco treatment. Methods: Data on seclusion and restraint incidents, voluntary commitment at admission for each hospitalization episode, and nicotine replacement therapy (NRT) prescriptions were collected through secondary analysis of Medicaid administrative records from baseline in January 2015 (n = 8983) to follow-up in December 2016 (n = 9685) at 14 inpatient psychiatric health facilities. Results: There were no significant changes from baseline to follow-up in odds of seclusion and restraint incidents or voluntary admission status. There was a significant increase in the odds of NRT prescriptions at both 30 and 180 days post discharge (odds ratio [OR] range = 1.58–2.09, P < .01). Conclusions: In a large, urban setting among Medicaid enrollees, implementation of a tobacco-free policy in inpatient psychiatric health facilities had no negative impact on behavioral problems or treatment access and improved access to NRT, although overall NRT use remained low. This study challenges perceptions among some providers that addressing tobacco use disorder will negatively impact treatment outcomes in individuals with serious mental illness. These findings support tobacco-free policies in psychiatric health facilities and the role of psychiatric health providers in treating tobacco use in this population, which is at high risk for tobacco-related mortality.

Keywords:

• Inpatients
• nicotine replacement products
• psychiatry
• smoke-free policy
• tobacco use cessation
  

Acknowledgments

The authors would like to thank Katy Kaplan, PhD for her contributions to the manuscript.

Author contributions

R.J. is now affiliated with Altru Health System. L.W. and J.S. designed, analyzed, and interpreted the data in collaboration with H.G.L. A.S. had primary responsibility for writing the manuscript in collaboration with H.G.L. R.J. and R.C. conceptualized the study. R.X., R.C., J.F., and F.L. designed and carried out the original study. R.J., R.C., and C.B. provided content expertise and provided substantive edits to the manuscript. All authors read, made revisions, and approved the final manuscript.

Additional information

Funding

Supplementary optional provider training for tobacco-free policy implementation was supported by a CVS Health Community Grant (“Access to Health Care for Underserved Populations”) to Community Behavioral Health. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.