Evidence informs much of what we do in health care, and that is true not just for clinical interventions, but also for decisions like the implementation of a new organizational policy. Understanding the evidence base for these types of initiatives can be particularly important when the issue is a challenging one that affects our staff, our clients, and our community.
CAMH’s decision to become a tobacco-free hospital is supported by research that speaks specifically to the issues involved in such a complex decision, and is particularly supported by new evidence that has come to light in the last five or six years. Understanding the link between evidence and policy is a key element to the success of our tobacco-free initiative, so we are committed to clear communication on the subject.
The evidence clearly tells us that our clients are disproportionately affected by smoking – in terms of rates of smoking as well as direct health outcomes and social impacts. In fact, the leading cause of death among people with serious mental illness and addictions is tobacco-related illness.
One of the common misperceptions that new evidence speaks directly to is the idea that tobacco use can somehow have a beneficial impact on the medical and psychiatric outcomes of our clients. Recent research, however, clearly demonstrates a link between smoking cessation and better treatment outcomes, and also tells us that there is no increase in aggression or violent incidents when smoke-free policies are implemented. Our own experience here at CAMH after our 2010 smoke-free policy change reflected this experience: a study conducted by our staff indicated there was no perceived change in levels of verbal or physical aggression, as corroborated by code white data.
There is also evidence specific to this type of policy implementation to guide us. Partial bans have been shown to be less effective than full bans, and facilities that have implemented tobacco-free policies have noted some significant benefits. Improvements in patient health outcomes, cleaner indoor and outdoor spaces, increases in staff satisfaction and more time to provide treatment have been reported. In addition to this research, we have the experience of other hospitals in Ontario to draw upon, many of which have already implemented full smoking bans.
This is just a small sampling of the recent evidence available that has helped to inform our decision to go tobacco-free. As we move forward with this important initiative, we’ll be communicating more about the role of research and evidence in our planning, implementation and evaluation of this important initiative.