New NICE guidance recommends that all NHS hospitals and clinics become completely smoke-free


Over 40% of all cigarettes smoked in England are smoked by people with severe mental illnesses. This group are more likely to become physically ill than the rest of the population, but they are less likely to be given help to quit.

Smoking is especially common among people with mental health problems: whilst 1 in 5 of the general population smokes, the figure rises to 1 in 3 among people with longstanding mental illness.

New public health guidance from NICE out this week looks to tackle these issues by helping people using acute, maternity and mental health services to stop smoking.


The new guidance recommends:

Where do you stand on this potentially explosive issue?

Where do you stand on this potentially explosive issue?

  • Strong leadership and management to ensure premises remain smoke-free
  • All hospitals have an on-site stop smoking service
  • Identifying people who smoke, offering advice and support to stop
  • Providing intensive behavioural support and pharmacotherapy as an integral component of secondary care
  • Integrating stop smoking support in secondary care with support provided by community-based services
  • Ensuring staff are trained to support people to stop smoking while using secondary care services
  • Supporting staff to stop smoking or to abstain while at work
  • Ensuring there are no designated smoking areas or staff-facilitated smoking breaks for anyone using secondary care services

As usual with this kind of NICE publication, there are a host of documents and resources to inform and bamboozle, pretty much in equal measure. The main links to the guidance itself, the supporting evidence, the relevant pathway and NHS staff podcast are all included below.

Sue Bailey, President of the Royal College of Psychiatrists, said:

There is a common but mistaken belief among some mental health professionals that it’s alright for patients in their care to smoke. This is wrong. Patients with mental health problems are far more likely to smoke than the general population, they suffer disproportionately higher rates of physical illnesses, and they die earlier. It’s a disgrace that this section of our NHS patient population is left to suffer the consequences of smoking.

Mary Yates, Matron at the South London and Maudsley NHS Trust said:

Having been actively involved in a smoke-free pilot in the South London and Maudsley NHS Foundation Trust, I have seen many patients with serious mental health problems cut down and successfully quit smoking whilst in our care. The new NICE guidance can help to change the culture whereby smoking is acceptable on NHS grounds and make it easier for hospital staff to set a clear example in helping patients to be successful in their attempt to quit smoking for good.

Paul Jenkins, CEO of Rethink Mental Illness said:

This new guidance is really important and timely. It is scandalous that so many people with mental illness are currently given no support to stop smoking.

What do you think of this new guidance?

We’d love to hear your thoughts:


  • Should mental health patients be encouraged to stop smoking when they are admitted to hospital with an acute illness?
  • Should NHS staff be forced to abstain from smoking at work?
  • Do you have personal experience of trying to quit smoking whilst mentally ill?
  • What’s the evidence regarding nicotine withdrawal and various mental health conditions?

Please share your thoughts in the comment box below.


PH48 Smoking cessation – acute, maternity and mental health services: guidance (PDF). NICE, 27 Nov 2013.

PH48 Smoking cessation – acute, maternity and mental health services: supporting evidence. NICE, 25 Nov 2013.

Smoking cessation in secondary care. NICE pathway, 2013.

PH48 Smoking cessation in secondary care: podcast for staff working within mental health trusts. NICE, 27 Nov 2013.

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