Experiences and Perspectives of Staff Working in a Forensic Mental Health Unit on the Use of E-Cigarettes by Service Users: A Qualitative Interview Study

Background

Smoking rates among forensic mental health service users are significantly higher than in the general population, exacerbating health inequalities. Although the long-term health effects of e-cigarettes are still unclear, they offer a potential harm-reduction strategy for smoking cessation. The introduction of e-cigarettes in complex forensic environments poses logistical challenges, safety concerns and varying needs for both service users and staff. Inconsistencies in e-cigarette policies across UK forensic settings are partly due to a lack of national guidelines. This study aims to explore staff perspectives in these settings to inform future guidelines and practices.

Methods

Qualitative semi-structured interviews were conducted with staff from low- and medium-security units within West London Forensic Services (WLFS) between September and November 2023. Thematic analysis was used to identify key themes.

Findings

Eighteen staff members, with a median tenure of 12 years, participated. E-cigarettes were seen as temporary substitutes rather than effective cessation aids, with many service users returning to smoking after discharge. Instances of misuse, including self-harm, trading and aggression, were reported, affecting clinical interventions and posing risks.

Interpretation

Frequent incidents related to e-cigarettes in forensic mental health settings pose risks to staff and service users with uncertain impact on smoking cessation, challenging the harm-reduction principles underpinning their use.