People with mental health problems smoke significantly more, have increased levels of nicotine dependency and are therefore at even greater risk of smoking-related harm than the general population. ^{Reference Cormac, Creasey, McNeill, Ferriter, Huckstep and D'Silva1,2}

We surveyed the smoking habits of in-patients on four adult open wards in Durham and compared them with those of the general UK population. The national statistics were obtained from Action on Smoking and Health Fact Sheets ³ and from the Office for National Statistics. ^{Reference Robinson and Bugler4}

The overall smoking prevalence for the in-patients was three times the national average (65% v. 21%). Addiction to nicotine can be measured by noting how long after waking a person smokes their first cigarette: 35% of in-patients and 16% of the general population had their cigarette in the first 5 minutes. Furthermore, 57% of the general population and 70% of in-patients said they would find it hard to go for a whole day without smoking. Worryingly, 78% of the in-patients said that they smoked more when they are admitted; the reasons given included boredom and a belief that smoking reduces side-effects of medication and causes weight loss. More than half of the patients (60%) expressed a desire to cut down smoking. It can be concluded that in-patients smoke more and are more addicted than the general population.

Following this survey, we have recommended that the in-patients should be offered advice on smoking cessation at the time of the admission and discharge. Treatment should also be offered routinely, particularly as a review of smoking cessation treatments for people with mental illness concluded that pharmacological aids that are given to the general population can be equally effective in helping people with mental illness to stop smoking. ^{Reference Campion, Checinski and Nurse5} However, care must be taken to avoid adverse medication interactions and to monitor antipsychotic medication in particular as cigarette consumption declines.

Boredom as an excuse for smoking should be challenged with structured occupational therapy programme. We also feel that patients should be encouraged to manage their weight by exercising and could be helped with advice from a dietician.

We would like to know if other readers have had similar experiences regarding smoking on in-patient wards, especially as there are plans to percolate the smoking ban down to lower levels of security. We are aware that some of the healthcare wings in prison are also now smoke free.