The Vanha Vaasa Hospital, situated in the Ostrobothnia region in Finland, made a significant change in 2025 by becoming the country’s first psychiatric hospital to switch to a smoke-free indoor environment. The forensic psychiatric hospital participates in the JA PreventNCD project pilot coordinated by Filha, which promote smoke-free workplaces and environments and develop tobacco and nicotine cessation practices in cooperation with social and health care.
In the words of Jussi Niemi, a respiratory nurse at the Vanha Vaasa Hospital: “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”. 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.
Psychiatric hospitals have traditionally allowed smoking indoors. While smoking is now prohibited indoors in Finland, including in prisons, psychiatric hospitals are one of the few places where indoor smoking is still permitted. “As part of the JA PreventNCD’s interventions, the hospital developed a tobacco and nicotine cessation model in addition to the smokefree indoors policy, and with this, patients will receive more effective support than before in quitting the use of nicotine products” explained Patrick Sandström, Filha's project manager.
Successful change needs thorough preparation
Jussi Niemi emphasised that it is worth starting the preparation for the change early and having an open discussion. From his perspective, it is important to empathise with patients’ concerns and feelings, as many patients may feel overwhelmed by the change and uncertain about the future. His recommendations include offering support, helping patients consider how they will cope in future and paying attention to staff concerns.
Preparations for the change began by organizing training on tobacco and nicotine cessation in each ward while discussing the upcoming change. The topic was brought up with 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.
In addition, 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.
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 as they 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 pointed out.
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. Therefore, efforts to communicate the harmful effects of nicotine itself to patients have been increased and, furthermore, nicotine cessation practices have been updated at the hospital.
Filhas experts in the JA PreventNCD project have provided guidance and support for implementing and carrying out the change. They have also trained staff on site, which significantly supported the promotion of smoke-free indoor environment and the development of tobacco and nicotine cessation programmes.
The experience of Vanha Vaasa Hospital shows that transitioning to a smoke-free psychiatric setting is not only feasible, but also beneficial for patients, staff and the overall care environment. This experience offers an encouraging and practical reference for other psychiatric hospitals and care institutions across Europe, demonstrating that health-focused and smoke-free environments can be achieved while respecting patients’ needs and supporting their recovery.