Implementation of a smoke-free policy appears to reduce physical violence in inpatient settings

COMMENTARY ON: Robson D, Spaducci G, McNeill A, et al . Effect of implementation of a smoke-free policy on physical violence in a psychiatric inpatient setting: an interrupted time series analysis. Lancet Psychiatry 2017;4,540–6. There is good evidence that promoting smoking cessation is particularly challenging in people with mental disorders or disabilities; individuals in this group are more likely to both smoke and find quitting difficult.1 Smoking contributes to the substantial health inequalities experienced by individuals with mental illness, including high rates of premature death.2 A critical barrier to the effective implementation of smoke-free policies in inpatient settings is fear among staff that they will result in increased physical violence. However, previous research on the effect of smoke-free policies on rates of violence has reported mixed results, but none have adequately controlled for other confounding factors that may influence violent outcomes.3 A comprehensive smoke-free policy was introduced in the South London and Maudsley NHS Foundation Trust (SLaM) on 1 October 2014. The present study was conducted between 1 April 2012 and 30 September 2015 to explore the effect of the implementation of …