The University of South Dakota Sanford School of Medicine

It seemed a little hypocritical to Ryan Lee, DO, helping patients in so many ways, only to allow them to harm themselves in another way. But that's the way it was up until a year ago at Aver Behavioral Health Center. Patients were getting all the psychiatric help they needed, but puffing away their health during smoke breaks on campus.

Dr. Lee, now a third-year psychiatry resident, found the whole scenario a bit odd and contradictory to ABHC's mission when he entered the program in 2007. "Psych patients deserve the same health benefits as other patients at the main campus." Both Sanford USD Medical Center and Avera McKennan Hospital campuses are smoke-free.

Dr. Lee approached ABHC administration about implementing a smoke-free policy. According to Steve Lindquist, Avera McKennan Assistant Vice President of Behavioral Health Services, the facility had a long-standing policy that allowed certain patients to smoke outdoors. In some cases, the ABHC was incidentally instrumental in reintroducing patients to smoking. "We'd see patients who had successfully stopped smoking prior to coming here, but started up again for social reasons once they began receiving treatment," Dr. Lee explained.  

A wellness committee was formed, but ABHC administration questioned whether a smoke-free environment would actually cause more problems between patients and staff. Lindquist said the administration questioned, "Is it the right time to not allow a person to smoke when they are going through a psychiatric crisis?" Staff could lose the leverage of revoking smoking privileges. Physicians worried if patients would delay seeking treatment because of the policy, with the end result being an increase in involuntary mental illness holds. Finally, there were concerns about the changes in patient metabolism of psychotropic medications that could be created through the varying levels of nicotine in the patient's system.

Dr. Lee took note of the administration's concerns and set out to prove that his proposal could work. He researched the health implications of smoking in psychiatric patients. He designed and distributed a survey to patients asking what obstacles would prevent them from seeking psychiatric help. Expense, embarrassment, and long commutes ranked highly. A smoke-free environment ranked very low. Dr. Lee said the survey was crucial in pushing his proposal forward.

Eventually, the committee and administration decided to adopt the smoke-free policy. Next, they had to decide to force patients to quit cold turkey, and gradually ease them into the policy. The committee decided to give plenty of advance notice, distribute pamphlets, and post signs indicating that October 1, 2008, would be the first smoke-free day at ABHC. A year later, the policy is widely regarded as a success.

"The change has gone very well," Lindquist commented. "Only positive outcomes have occurred."

"It has gone much better than the staff thought it would," Dr. Lee adds. "People who were oppositional at first have told me, 'Great job'."

ABHC offers nicotine replacement materials to assist patients who still have the urge to smoke. Dr. Lee said physicians and staff have gotten good feedback from patients who wanted to quit but needed a boost. 

ABHC was awarded the Avera Quality Congress Award for the implementation of the smoking cessation project.