Abstract
Abstract.Background: The prevalence of tobacco smoking among people with severe mental illness (SMI) substantially exceeds smoking rates in the general population and has been identified as the largest contributor to health inequalities in this group. Historically deeply embedded in the culture of mental health treatment environments, smoking until very recently was the norm in inpatient settings and still prevails in many settings internationally. In England however, mental health Trusts are currently implementing recent national guidance, according to which mental health settings will become entirely smokefree, with no exemptions, providing comprehensive evidence-based support to patients for smoking cessation and smoking abstinence during the inpatient stay. Aim: The aim of this article is to summarise the rationale for and the debate surrounding smokefree mental health inpatient settings, and to review and discuss the evidence on challenges, opportunities and impact of smokefree policy implementation in these settings, with a focus on the English debate and experience to date.
Zusammenfassung.Hintergrund: Im Vergleich zur Allgemeinbevölkerung sind Tabakrauchprävalenz und Tabakabhängigkeit in dem Teil der Bevölkerung, der an psychiatrischen Erkrankungen leidet, stark erhöht – so stark, dass Rauchen den größten Anteil an den Unterschieden in der gesundheitlichen Situation dieser Bevölkerungsgruppe darstellt. Das Rauchen von (und mit) Patienten ist in der systemischen Kultur der Psychiatrie historisch tief verwurzelt und bis heute international vielerorts weitgehend noch immer als Norm akzeptiert. In England allerdings sind psychiatrische Einrichtungen derzeit im Begriff, neue Richtlinien zu implementieren, die ein komplettes Verbot des Rauchens während der stationären psychiatrischen Behandlung bei gleichzeitig umfassender evidenzbasierter Behandlung der Tabakabhängigkeit vorsehen. Ziel: Dieser Beitrag gibt einen Überblick über die wissenschaftliche und praxisorientierte Debatte zum Thema „rauchfreie Psychiatrie“ mit Fokus auf Erfahrungen aus England, und bietet kritische Reflektion in Bezug auf die hiermit in Zusammenhang stehenden Herausforderungen, Möglichkeiten und Konsequenzen.
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