Systemic barriers to quitting smoking among institutionalised public mental health service populations: a comparison of two Australian sites.

BACKGROUND: This article reports the findings from a comparative study investigating smoking behaviours among institutionalised psychiatric populations from a sociological perspective.
METHOD: The study involved participant observation of two separate Australian sites between 1999 and 2002, the second site serving to generalise the findings from the first site. DISCUSSION AND
CONCLUSIONS: Systemic barriers to quitting were identified, emanating from the mental health system in general. Cigarettes were identified as the currency by which economic, social and political exchange took place between participants who described an enculturation process that involved complex processes of reinforcement to smoke. Once entered into, escape from the smoking culture of the settings appeared to be extremely difficult for clients and staff.