Nicotine addiction among the mentally ill occurs at a high rate and aggressive behavior frequently occurs in forensic psychiatric facilities. Few studies focused on psychiatric forensic inpatients and their behavioral response to nicotine withdrawal. This study was an analysis of the association between nicotine and aggressive acts, reported in Special Incident Reports, before and after a smoking ban at a forensic hospital. The findings indicate a notable increase in aggressive acts in the week following implementation of a smoking ban with a parallel rise in use of seclusion and restraint. A significant decrease in self harm and a notable increase in aggressive acts to other patients occurred following the ban.

Further research is needed to examine the relationship between nicotine withdrawal and aggressive inpatient behavior. Violence in forensic psychiatric settings is an occupational hazard to nursing staff and a better understanding of violence will improve staff safety and clinical care.