Experiences and Perspectives of Staff Working in a Forensic Mental Health Unit on the Use of E‐Cigarettes by Service Users: A Qualitative Interview Study

Background Smoking rates among forensic mental health service users are significantly higher than in the general population, exacerbating health inequalities. Although the long‐term health effects of e‐cigarettes are still unclear, they offer a potential harm‐reduction strategy for smoking cessation. The introduction of e‐cigarettes in complex forensic environments poses logistical challenges, safety concerns and varying needs for both service users and staff. Inconsistencies in e‐cigarette policies across UK forensic settings are partly due to a lack of national guidelines. This study aims to explore staff perspectives in these settings to inform future guidelines and practices. Methods Qualitative semi‐structured interviews were conducted with staff from low‐ and medium‐security units within West London Forensic Services (WLFS) between September and November 2023. Thematic analysis was used to identify key themes. Findings Eighteen staff members, with a median tenure of 12 years, participated. E‐cigarettes were seen as temporary substitutes rather than effective cessation aids, with many service users returning to smoking after discharge. Instances of misuse, including self‐harm, trading and aggression, were reported, affecting clinical interventions and posing risks. Interpretation Frequent incidents related to e‐cigarettes in forensic mental health settings pose risks to staff and service users with uncertain impact on smoking cessation, challenging the harm‐reduction principles underpinning their use.