This report presents the findings of an ASH survey of NHS mental health trusts in England, conducted between October and December 2024. This is repeat of a previous survey in 2019. Findings are from 40 of the 50 NHS trusts that provide inpatient mental health care to adults in England.

Key findings:

• The research found that 70% of mental health trusts now offer quit support to patients who smoke. However, only 42% of trusts report that they are able to offer support to all patients who smoke.
• There have been few changes in smokefree policies since 2019, with 85% of trusts reporting they had a policy. Smoking was still permitted onsite in 15% of trust.
• Breaches to smokefree policies are common. While smoking indoors has declined since the last survey, smoking on hospital grounds remains commonplace. Half (48%) of trusts reported some smoking on hospital grounds every day, with a similar number (50%) reporting that staff escorted patients to smoke daily, contradicting NICE guidance.
• Section 17 leave was used to facilitate smoking breaks in 33% of trusts, despite CQC guidance stating that this undermines smokefree policies and “the principles of the duty of care to protect health.”
• Access to vaping products was seen as an important way to support smokefree policies and help patients stay smokefree.
• Organisational culture and lack of funding were identified as critical barriers to progress in supporting more people to be smokefree.
• Very few trusts offered varenicline (15%), cytisine (13%) or buproprion (8%) to patients despite their effectiveness for smoking cessation, including among people with mental health conditions.

Recommendations:

1. Provide secure funding for tobacco dependence treatment services in mental health trusts.
2. Produce national guidance to ensure that healthcare settings are prepared for any changes in the law and reduce variation in service delivery.
3. Ensure that comprehensive implementation of tobacco dependence treatment services and smokefree policies is a priority for all staff.
4. Improve access to varenicline and cytisine, which are under-prescribed to people with mental health conditions, alongside consistent access to vapes and NRT.
5. Ensure all staff working in mental health trusts receive mandatory training to address widely-held misconceptions about the impact of smoking on mental health.

Links:

• Press release: Patients in mental health wards need better quit support as government prepares to ban smoking on hospital grounds
• Coverage in the Health Service Journal: Patients routinely smoking in hospitals, despite ban
• Op ed in the Health Service Journal by Sir Norman Lamb, chairman of the South London and Maudsley Foundation Trust: Mental health trusts must get tougher on smoking