Risk management is the key to comprehensive tobacco control in mental health services

Introduction: Traditionally, tobacco use has been an accepted practice in mental health services all over the world. In recent years practice in Ireland and many other countries has changed dramatically in line with changes in other health service settings and services. The Best Practice Guidelines for Tobacco Management in the Mental Health Setting, provides mental health services with direction and support. However, the key to effective tobacco policy implementation in these settings lies in the ability to address and resolve conflicts between service goals; providing safe best practice care to clients and protecting staff and public from exposure to second hand smoke. This requires the use of a client centered risk assessment process which ensures that ALL staff have had clear direction on how to manage difficult situations.

Methods: The ENSH Gold Forum process has afforded us a unique opportunity to identify examples of best practice in tobacco management in healthcare settings. The identified examples are presented and peer-reviewed by national and global experts. One such example demonstrated a comprehensive risk assessment process with tools which provides clear direction on the management of tobacco in particularly difficult client situations. It was developed by a teaching hospital in Dublin St Vincent's University Hospital. It incorporates a multi-disciplinary approach with a focus on the client care plan, a weekly review process and on-going evaluation by a strategic group. This got a very positive review through the ENSH Gold Forum process first in 2010 and again in 2014 where the hospital became one of the first hospitals to retain their ENSH Gold Forum membership for a second time. This is now being adapted for use in all acute mental health services in Ireland.

Results: The risk assessment process and tools will be presented with a focus on monitoring and continuous improvement.