The Impact of a Comprehensive Smoke-Free Policy on Psychiatric Inpatient Freedom and Nicotine Prescriptions: The Case of UMC Utrecht Hospital from a Sociological Perspective

Abstract

The UMC Utrecht’s Department of Psychiatry implemented the “Towards a Smoke-free Generation” policy in November 2020, following the Dutch National Prevention 2018 Agreement. This comprehensive smoke-free policy aimed to promote healthier lifestyles and reduce second-hand smoke’s impact within hospital premises, extending the prohibition to the psychiatric unit’s internal smoking areas. The current study evaluates the impact of the policy on the inpatient population by analysing daily observations from electronic inpatient dossiers (EPD) obtained via the clinical repository HIX, a Digital Health Services platform. The analysis covers two distinct periods: pre-implementation (July 1, 2017, to October 31, 2020), when indoor smoking was permitted, and post-implementation (November 1, 2020, to February 27, 2024) with the smoke-free area implemented. Multilevel binary logistic regressions were conducted to assess the policy’s influence, focusing on psychiatric freedom permits and prescribed nicotine replacements. The findings reveal a significant increase in non-limited psychiatric permits (green and yellow permits) during the first freedom assessment post-policy implementation. Moreover, the policy has driven changes throughout inpatients’ hospitalisation in increasing the likelihood of smokers receiving limited permits (red and orange permits) and non-smokers obtaining non-limited permits (green and yellow permits). Additionally, the smoke-free policy has amplified the odds of smokers being prescribed nicotine replacements, indicative of its support for smoking cessation. Furthermore, the policy has been effective in reducing possible pressures from smokers on staff during potentially biased freedom assessments, thereby discouraging smoking as a coping mechanism. Overall, the current research findings suggest that the smoke-free policy, alongside a freedom permit system, effectively promotes cessation prescriptions and addresses smoking behaviours and social beliefs. Therefore, contributing to a physically and mentally healthier psychiatric environment.