Factors associated with success of smokefree initiatives in Australian psychiatric inpatient units: Lessons for progressing smokefree mental health in the UK

Internationally, there is increasing pressure on psychiatric care settings to adopt smoke-free policy. This study examined smoke-free policy across psychiatric inpatient settings in Australia and aimed to identify factors that may contribute to success or failure of smoke-free initiatives to better inform best practice in this important area. Semi-structured in-depth telephone interviews were conducted with senior administrators and clinical staff with direct day-to-day experience of smoking activities in 99 adult psychiatric inpatient settings across Australia (psychiatric units within general hospitals represented 58% of the national sample). Quantitative analysis, qualitative thematic analysis, and case studies were undertaken. The integration of a range of variables associated with leadership, teamwork, training, NRT use, staff smoking and other variables, as part of effective change management, were found to be important for implementing and sustaining smoke-free policy. Lack of staff cohesion was a significant factor found to undermine smoke-free policy. Features for success and ongoing sustainability of smoke-free policy were identified.