The Institut national de psychiatrie légale Philippe-Pinel has been proudly smoke-free since October 31, 2005. This was the result of some two years of work by the Institut’s A Smoke-free Hospital committee and a willingness to promote the health of patients and personnel. In 2006, the Institut was awarded the Prix d’excellence du réseau de la santé et des services sociaux for this initiative.
Project History
In December 2003, the Institut envisioned a hospital that was entirely smoke-free to help promote the health of patients and personnel, as well as to meet the requirements of the Tobacco Act (L.R.Q. Chapter T-0.01). Discussions began with the Institut’s senior management to not only conform with but also be proactive when it came to the law. A team was put together by General Management to get the project underway, giving our A Smoke-free Hospital project got its start.
A Bold Project
The Institut long believed that it was unreasonable—even unthinkable—to ask individuals with a psychiatric illness to quit smoking. There were numerous misgivings: The Institut has patients living here for long periods of time, and it was thought that quitting smoking could provoke violent reactions or an increase in delinquency.
A Mobilizing Committee with a Gentle Approach
Despite these misgivings, the CEO requested an ad hoc committee be put together, consisting of representatives from different professions at the Institut. Within a year, all units at the Institut were onboard with the project, which was conducted with a gentle approach.
A First Smoke-free Unit
In spring 2004, one unit at the Institut volunteered to start the pilot project. Personnel from the admission-readmission-psychiatric expertise unit worked to ensure patients living in the unit could benefit from a smoke-free environment with support throughout the process—all with the goal of optimizing their mental and physical health. October 4, 2004, was set as the date this first unit would become completely smoke-free.
One Victory Leads to Another
Gradually, this success found its way into each of the Institut’s units. A combined effort from senior management, the committee, employees, and patients enabled the Institut to offer a completely smoke-free environment starting October 31, 2005. What’s more, this process did not increase violent behaviour or complaints concerning smokers’ rights.
Daily Support
The committee for A Smoke-free Hospital put together tools and ideas to encourage staff and patients to quit smoking, organized awareness activities, and made use of all available resources to reach their objectives. With the committee’s support, personnel were able to conserve the latitude and autonomy needed to meet the specific needs of patients in their units. For every unit who met their smoking cessation goal, all costs for those who quit their habit were covered by the Institut (nicotine patches, kits, documentation, special snacks, gum, etc.).
Smoke-free: Unexpected Side Effects
The project for A Smoke-free Hospital also took part in the Institut’s research project on clozapine. This psychiatric medication is one of the most effective smoking cessation tools in the right dosage, and requires strict monitoring. The research project is still ongoing, but it’s clinically estimated that some 20% of the global reduction in the prescription of the drug has also proportionally decreased the side-effects related to the use of the medication. For patients, this means smaller dosages to obtain the same clinical results with a positive impact on the Institut’s medication budget.
More Active Lifestyles
A general increase in the level of physical activity in patients was also observed. Care units has to increase the number of activities offered to meet patient demand and limit downtime that can trigger individuals to start smoking again. By engaging in more physical activity, patients also increased their cardiovascular capacity. Patients were given pedometers to encourage walking, which also helped to increase their physical activity.
An Economic Benefit for Patients
Patients’ bank accounts were a non-clinical way to measure the success of our smoking cessation program. Smokers were using almost all their restrictive budgets to purchase cigarettes, and had little left over for anything else. By eliminating this expensive habit, they suddenly had access to other ways of improving their quality of life (clothing, entertainment, treats, etc.).
Benefits Across the Network
Since the Tobacco Act came into effect on May 31, 2006, interest in the Institut’s smoking cessation project continues to grow. As well as piquing the interest of many partners in the healthcare network, the project was also used in scientific presentations across Québec, Europe, and around the world. The Institut’s expertise is now a reference point for other such projects.