Psychiatric hospitals have traditionally allowed smoking indoors. While smoking is now prohibited indoors, including in prisons, psychiatric hospitals are one of the few places in Finland where indoor smoking is still permitted. The use of tobacco and nicotine products is also very common in psychiatric hospitals. In 2025, the interior of the Vanha Vaasa Hospital was declared a smoke-free zone. The pace of change and the experiences have brought a positive surprise.
Jussi Niemi has worked as a nurse at the Vanha Vaasa Hospital for seven years. He has been a respiratory nurse since 2022, and his duties also include promoting smoke-free and nicotine-free living.
– In 2024, we conducted a hospital-wide survey of patients, and approximately 50 percent of our patients reported that they smoked, while 75 percent reported that they used some kind of nicotine product, Jussi Niemi says.
The indoor smoke-free policy at the Vanha Vaasa Hospital began in the ward where Jussi Niemi works. The nursing staff initiated a pilot project with the hospital’s management team who gave their permission. Patients have previously had the opportunity to smoke indoors in designated areas, but, as a result of the transition, the interior spaces of the pilot ward were declared smoke-free zones, and smoking is now allowed only outdoors.
The experiences in the pilot department were so positive that after a month, the other departments in the hospital wanted to join the reform.
-The reform proceeded relatively quickly. In April, the first ward began the trial, and by September, the last ward was declared a smoke-free zone, says Jussi Niemi.
The reform was partly accelerated by the preparation of a new hospital building, as no indoor smoking facilities were planned for it. In addition, the Parliamentary Ombudsman’s ruling, according to which hospitals do not have to separately organize indoor smoking facilities for patients in involuntary care, played a role.
Open discussion about change
Jussi Niemi emphasizes that it is worth starting the preparation for the change early and having an open discussion. It is important to empathize with patients’ concerns and feelings, as many patients can feel that the change is big and a cause of uncertainty. It is recommended to offer support and help patients consider how to cope in the future. It is also worth paying attention to the concerns of the staff. When the preparation and dialogue are handled well, patients are more likely to adapt to the change smoothly.
– The change was criticized by some individual patients. However, the criticism quickly subsided, Jussi Niemi says.
Preparations for the change began by organizing training on tobacco and nicotine cessation in each ward while discussing the upcoming change. Ward nurses have continued discussion in community meetings and staff meetings. The topic was brought up to patients at an early stage. This way, the change did not come as a surprise, and patients and staff were given enough time to adapt and prepare.
At the Vanha Vaasa Hospital, patients are offered support to quit smoking and the use of nicotine products through individual and group counseling. As part of the treatment, the hospital offers free-of-charge nicotine replacement therapy to patients who are committed to quitting.
Effects of smoke-free indoor air
The change offered many positive effects for both patients and staff.
As a result of the change, many patients have cut down their smoking, and chain smoking, in particular, is now less common. When indoor smoking was allowed, some patients used to smoke every fifteen minutes, but with outdoor smoking, many patients have voluntarily reduced their smoking. In addition, outdoor smoking has significantly increased the physical activity of patients. Patients in hospital wards have the opportunity to go outside at least three times a day.
This, in turn, has had a positive impact on patients’ lung health and their treatment.
– The quality of indoor air has clearly improved in sensory-wise, meaning that the inside no longer smells of tobacco in the same way, and the indoor air is also fresher to breathe in, Jussi Niemi continues.
Tobacco is expensive, which has caused financial pressure on smoking patients. This financial pressure is usually accompanied by unpleasant side effects, such as scrounging, running into debt, and even abuse. We have witnessed a decrease in these side effects, and there are fewer conflict situations and tensions associated with indoor smoking between patients.
This has freed up more time for nursing work.
– If supervised smoking occurs once an hour throughout the day, ending supervised smoking will significantly free up resources for other more sensible activities, such as patient rehabilitation. Enabling smoking and spending time on it does not support anyone’s rehabilitation, Jussi Niemi reflects.
Development work continues
However, while smoking has decreased, a significant increase in the use of nicotine pouches has been observed. Patients’ use of nicotine products is diverse: some smoke, some use nicotine pouches, and some use e-cigarettes.
– This requires even more expertise and updating the expertise of the nursing staff. It is important to provide and organize training about the use of nicotine products for patients, Jussi Niemi states.
Efforts to communicate the harmful effects of nicotine itself to patients have been increased and, furthermore, quitting practices have been updated at the hospital.
– Health promotion will be implemented step by step, and the increased use of nicotine pouches will be a key focus in the future. Patients have already been informed about the harms of nicotine, but now, we are investing even more in the matter, Jussi Niemi continues.
At the same time, a network of respiratory care coordinators was developed for departments. Each department has its own responsible nurse who promotes nicotine-free and smoke-free living and acts as a contact person. The hospital has been offering this service since 2016, but recently, the service has been further strengthened and clarified to make it as structured and functional as possible.
JA PreventNCD project: expert support, networking and training
The Vanha Vaasa Hospital is participating in a EU-funded JA PreventNCD project pilot coordinated by Filha, aim of which is to develop tobacco and nicotine cessation practices in social and health care services and psychiatric hospitals, and to promote smoke-free workplaces and environments.
– The project and participation in the Forerunners Network have helped us significantly in implementing the change. The project and the network have motivated and encouraged the change, says Jussi Niemi.
– The Forerunners Network consists of the four psychiatric hospitals participating in the JA PreventNCD project (HUS Psychiatry, TYKS Psychiatry, Niuvanniemi Hospital, and Vanha Vaasa Hospital), where practices related to smoke-free and nicotine-free living are developed together, says Patrick Sandström, project manager of the Filha pilot.
The project experts have provided guidance and support in implementing and carrying out the change. They have also trained staff on site, which significantly supported the promotion of smoke-free indoor air and the development of tobacco and nicotine cessation.
– Networking with other organizations has been very valuable. We have exchanged experiences about the situations and plans of different hospitals to promote smoking-free living.
The Vanha Vaasa Hospital is in close cooperation with Niuvanniemi Hospital, for example, which has increased practical cooperation between the two state mental hospitals. The process has created a mutual dialogue and support that has not existed before.
Based on the experiences of the Vanha Vaasa Hospital, Jussi Niemi also encourages other psychiatric hospitals to join in promoting smoke-free indoor air.