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A study evaluating the experience of 12 mental health wards before and after implementing the NICE guidance found: an increase in patients being offered smoking cessation advice a decrease in challenging behaviour incidents patients reporting positive changes in their smoking behaviour patients reporting motivation to maintain change after discharge The most commonly identified barriers to smokefree policy implementation were: staff resistance patient resistance insufficient resources lack of senior management leadership Stop smoking services in community mental health settings An ASH survey of community-based mental health nurses and psychiatrists and local authority stop smoking services was carried out to gauge the level and quality of support available to smokers with mental health conditions living in the community

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Chest CT without IV contrast, lung parenchyma window and axial slices (C and D)