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Georgia Public Psychiatric Hospital System Goes 100% Tobacco Free

By Tom Wilson, GA Dept of Behavioral Health and Developmental Disabilities

Published in the NAMI Augusta Azalea, January 2010

On January 5, 2010, Georgias seven state and regional psychiatric hospitals will go completely tobacco-free. Why?

1. Its good for the health of consumers and staff.

Psychiatric hospitals are health care facilities.

Recognizing that, at least 41% of state mental health facilities nationwide prohibit tobacco use on their facility grounds. (1)

Tobacco kills.

People with mental illness die 25 years sooner than the general population, in no small part due to their higher than average use of tobacco. (2)

The smoking rate in Georgia overall is 19.5%. The smoking rate for people with mental illness nationally is more than twice that. (3)

Nearly 75% of people with substance abuse disorders or mental illness smoke. (2)

People with mental illness consume nearly half of all cigarettes in the U.S. (2)

Some studies also suggest that treatment staff in mental health and substance abuse facilities and programs are more likely to smoke than the general population: 30 - 40% as opposed to 20% in the general population.

Second-hand smoke kills.

A study by the Institutes of Medicine found that cities that instituted smoking bans saw a reduction in heart attacks and heart disease from secondhand smoke of anywhere from 6 to 47%. (4)

2. Its good for treatment.

The role of treatment is to provide consumers with healthy, sustainable ways of coping with their illness.

Smoking can interfere with the effectiveness and safety of medications.

The byproducts of smoke stimulate the liver to metabolize antipsychotic medications quicker. (5)

That means smokers require higher doses to achieve the same therapeutic effects.

It also means theyre at higher risk of side effects from those higher doses. (6)

No evidence of adverse effects.

Although people with mental illness may face difficulties quitting smoking, studies have demonstrated that their symptoms DO NOT worsen when theyre admitted into a tobacco-free psychiatric facility. (7)

Short-term v/s long-term benefits.

Although smoking does provide a short-lived calming effect, long-term smoking abstinence has been shown to lead to a more lasting decrease in anxiety. (8)

Smoking is correlated with bad outcomes for people with schizophrenia.

Research has shown that people with schizophrenia who are the heaviest tobacco users have poor long-term outcomes. (9)

They require more psychiatric services, more hospital admissions, and more injections of antipsychotic medications than non-smoking patients.

Those most heavily dependent on nicotine have the highest proportion of hospital admissions. (10)

People with schizophrenia begin smoking on average eight years BEFORE their first symptoms appear. (11)

3. Its good for the safety of staff and consumers

Results in positive behavioral changes.

State mental health facilities that went completely tobacco-free reported a decrease in behavioral problems related to smoking, decreased violence, and increased staff satisfaction after the tobacco bans. (1)

Does NOT result in often expected negative changes.

No increases in aggression, use of seclusion, discharges against medical advice, or increased use of as-needed medications for agitation have been documented following smoking bans especially where the bans covered the entire facility premises. (12)

Reduces aggression.

One hospital that tracked physical and verbal aggression before and after their tobacco ban found verbal aggression decreased 45% and physical aggression decreased 50% in the first few months after the ban. (13)

The same hospital found that incidents of aggression continued to decrease every year, resulting in a significant decrease in staff injury rates for four consecutive years.

Smoking is correlated with suicide risk.

Among people with severe depression, its been shown that smokers are twice as likely to have attempted suicide than nonsmokers and that smokers are at a 43% greater risk of suicidal thoughts. (14)


1. 2006 survey by the National Association of State Mental Health Program Directors (NASMHPD)

2. National Association of State Mental Health Program Directors (NASMHPD), Tobacco-Free Living in Psychiatric Settings, 2007

3. Centers for Disease Control, Morbidity and Mortality Weekly Report, Vol. 58 No. 44, November 13, 2009

4. Institute of Medicine, Secondhand-smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence, 2009

5. Hiral D. Desai, Julia Seabolt & Michael W. Jann, Smoking in Patients Receiving Psychotropic Medications: A Pharmacokinetic Perspective, 15 CNS Drugs 469, 470 (2001).

6. Jose De Leon, Scott C. Armstrong & Kelly L. Cozza, The Dosing of Atypical Antipsychotics, 46 Psychosomatics 262, 26566 (2005).

7. Cedric M. Smith et al., Obligatory Cessation of Smoking by Psychiatric Inpatients, 50 Psychiatric Services 91, 94 (1999); Ellen Haller, et al., Impact of a Smoking Ban on a Locked Psychiatric Unit, 57 J. Clinical Psychiatry 329, 332 (1996).

8. Robert West & Peter Hajek, What Happens to Anxiety Levels on Giving Up Smoking, 154 Am. J. Psychiatry 1589, 1589 (1997).

9. Ciara Kelly & Robin G. McCreadie, Smoking Habits, Current Symptoms, and Premorbid Characteristics of Schizophrenic Patients in Nithsdale, Scotland, 156 Am. J. Psychiatry 1751, 1752 (1999)

10. M. Carmen Aguilar et al., Nicotine Dependence and Symptoms in Schizophrenia: Naturalistic Study of Complex Interactions, 186 Brit. J. Psychiatry 215, 215 (2005)

11. S. Levander et al., Nicotine Use and Its Correlates in Patients with Psychosis, 116 ACTA Psychiatrica Scandinavica 27 (2007)

12. Grant T. Harris et al., Effects of a Tobacco Ban on Long-Term Psychiatric Patients, 34 J. Behavioral Health Services & Res. 43, 44 (2007)

13. North Texas State Hospital in Wichita Falls, Texas. John Quinn et al., Results of the Conversion to a Tobacco-Free Environment in a State Psychiatric Hospital, 27 Admin. & Poly Mental Health 451 (2000)

14. Antti Tanskanen et al., Smoking and Suicidality Among Psychiatric Patients, 155 Am. J. Psychiatry 129, 129 (1998)

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