Housing evidence / case study · working draft
South London and Maudsley: smoke-free mental-health care
A mental-health trust paired its smoke-free policy with treatment, staff preparation and patient involvement.
01 / THE APPROACH
What was tried
South London and Maudsley introduced a comprehensive smoke-free policy across inpatient services, supported by nicotine-dependence treatment and staff preparation.
Patient involvement also shaped the trust's evolving approach to vaping. Public Health England's later case study describes individual risk assessments, treatment plans and clear rules about where vaping could take place. These later arrangements should be distinguished from the policy evaluated in 2014–15.
02 / THE FINDINGS
What was learned
Researchers examined 4,550 physical assaults recorded over 30 months before and 12 months after the policy. After adjustment for other factors, the monthly assault rate was 39% lower following introduction.
The finding challenges the assumption that a supported smoke-free policy inevitably increases violence.
03 / TRANSFER TO WALES
What Wales could learn
The trust combined a smoke-free policy with preparation and nicotine-dependence care. Patient input also informed later arrangements for vaping within individual care plans.
The useful learning is that changing the environment involves clinical support and staff practice. The observed fall in assaults should not be presented as proof that the policy alone caused it.
Sources & review
Robson et al. (2017), The Lancet Psychiatry 4, 540–546, DOI 10.1016/S2215-0366(17)30209-2. Implementation context: Public Health England case study, section 11. Primary sources checked 23 October 2026. Later vaping arrangements are not presented as the cause of the earlier assault result.
