Abstract
Objective: The aims of the present paper are to describe the experiences of patients and staff regarding smoking and violence in locked inpatient settings, and to stimulate debate about the role of nicotine withdrawal in contributing to those experiences.
Method: Interviews were performed with 24 patients and 26 staff attached to a stand-alone psychiatric hospital. Participant observation of the inpatient setting was performed over a 6-month period. Data were triangulated and thematically analysed using the grounded theory method, ethnographic method, and descriptive and inferential statistics.
Results: Staff used cigarettes to clinically manage patients’ symptoms and behaviour. A combative environment existed between patients and staff, fuelled by staff controlling the supply of cigarettes to patients. Physical structures separating staff and patients heightened this problem. Nicotine withdrawal appeared to be misattributed for signs of impending violence or illness relapse. No nicotine replacement therapy was given to patients and no staff acknowledged patients’ nicotine withdrawal other than to ensure the continued supply of cigarettes to patients.
Conclusions: In locked psychiatric settings, staff appear to use cigarettes to clinically manage patients and to avoid violence by patients. No clear clinical strategies for addressing nicotine withdrawal within psychiatric locked settings appear to exist.
