Introduction:
Even today, psychiatric hospitals are exempted from smoke free environment. But with the implementation of the amended Health Promotion Act of the July 1st, 2019, all of the hospital in Japan including psychiatric ones became in principle smoke free in their premises.

Objectives:
To share the information and problems for making hospital smoke free and to execute the hospital total smoking ban smoothly among the psychiatric hospitals in Kyoto Prefecture.

Methods:
We send a questionnaire to psychiatric hospital administrators in Kyoto Prefecture before and after the enforcement of the Act.

Results:
Before the implementation, 5 out of 12 (42%) hospitals were smoke free in their premises, 3 (25%) were smoke free indoors and 4 (33%) had indoor separated smoking area. After the implementation, 10 out of 16 (67%) hospitals become smoke free in their premises; and 5 (33%) were smoke free indoors. Although about half of the hospitals replied that no problem in particular happened, closet smoking and smoking around hospitals remain as challenges. Only two hospitals provided treatment for smoking cessation by health insurance and there was little support system for quitting tobacco.

Conclusion(s):
We reported results of the questionnaire to the surveyed hospitals and could share the information for tobacco control measures of other hospitals. This study contributed to a smooth implementation of the smoking ban of psychiatric hospitals. Support for patients and hospital staffs to quit tobacco is the next agenda.