As tobacco use is the leading cause of preventable death and disease, it is the responsibility of healthcare agencies, such as hospitals, to provide a healthy and safe environment, free from exposure to second-hand smoke, and tobacco related triggers. Further, as a mental health and addictions treatment facility, it is CAMH’s responsibility to be a system leader in de-normalizing tobacco use on hospital grounds, and developing treatment and care plan supports to assist those patients with a goal of tobacco reduction or cessation. This is particularly critical within our patient population as persons with mental illness and substance use disorders smoke at a higher prevalence rate than the general population, and are less likely to be perceived as capable and/or interested in smoking cessation (which the evidence consistently contradicts).

This initiative, therefore, is a culture change initiative, aiming to lower the impact of tobacco related complications by decreasing exposure to second hand smoke and increasing access to- and the opportunity for withdrawal management and/or smoking cessation supports.

For the purpose of clarity, the tobacco free initiative does not aim to make all persons quit smoking, but rather aims to:
• Create a healing environment, free from tobacco related triggers and exposure to second hand smoke
• Increase mindfulness related to the triggering impact that smoking has on those in a quit attempt
• Increase education and awareness of the relationship between tobacco use and mental health and addiction
• Provide withdrawal management/smoking cessation supports for patients with mental illnesses and addictions
• Support the goals of staff and patients wanting to make changes to their tobacco use

What makes this practice creative and innovative? While several hospitals in Canada are Smoke Free, CAMH is the first agency to become Tobacco Free (includes all tobacco products, smoked, or otherwise). CAMH is also the first health agency in Canada to discuss the impact of tobacco related triggers as part of their smoke free policy. As part of our initiative, tobacco and tobacco related products must be kept out of sight at all times on our property in order to reduce the likelihood of triggering those in the process of tobacco reduction/cessation. Furthermore, unlike other agencies across Ontario, CAMH sees tobacco-free as a clinical, care planning initiative, rather than one focused on enforcement. As part of this initiative, CAMH aims to support both patients and staff that smoke, by providing them with evidence-based strategies (behavioural and biological) for smoking cessation and/or the management of withdrawal.

Since the implementation of Tobacco Free at CAMH, staff, and patient attitudes have shifted favorably, exposure to second hand smoke and tobacco litter has been reduced, and there is an increased mindfulness of tobacco related triggers on our grounds. More staff are engaging in respectful conversations with persons observed smoking on the property, and areas previously smelling of smoke, now smell fresh and clean. Clinically, patients and staff now have increased access to smoking cessation/withdrawal management supports and an increased dialogue related to tobacco use is taking place on our campus. Our staff and community are reporting increased education and awareness about the negative health impacts of tobacco use, and collaboratively we are working towards a culture that supports recovery from nicotine addiction.

Contact Information:

Title: Project Manager

Contact information: lilian.riadallen@camh.ca

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