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PHOENIX — Arizona's state mental hospital has banned all smoking on its grounds, putting the brakes on a habit that saw as many as 100 percent of patients in some units regularly lighting up.

The ban at the Arizona State Hospital in Phoenix covers not only patients but staffers and visitors at the Van Buren Street complex.

The move comes years after smoking bans were enacted in other public places in the state, including jails and other state mental facilities.

Hospital CEO John C. Cooper began planning the policy a year ago in response to a 2006 report detailing the death rates of psychiatric patients in public facilities across the nation.

"It said that our people die 25 years before people who don't receive our services, and the reasons were all smoking-related," he said. "It was shocking. We're a health-care agency, and we were doing things that are not healthy."

Previous hospital policies practically encouraged people with serious mental illnesses to smoke. Some patients' daily schedules included as many as 20 cigarette breaks.

The report by the National Association of State Mental Health Program Directors reported that about 60 percent of public mental-health facilities allow smoking.

Smoking has lingered at mental-health facilities for several reasons, among them the sentiment long held by even doctors that smoking is one of the few pleasures left to troubled patients.

"I've done nothing in my career except psychiatry, and we've been hesitant to go there with our patients," Cooper said. "Some felt, 'These poor things. This is the only thing they have left.' "

And, too, the hospital is essentially the residents' home, and regulating behavior at home is a tricky issue, according to Anand Pandya, a psychiatrist and president of the board of directors of the National Alliance on Mental Illness, a patients advocacy group.

"There was concern that going smoke-free may discourage people from getting psychiatric treatment," said Pandya, who is also director of inpatient psychiatry at Cedars-Sinai Medical Center in Los Angeles.

"And also concern that for people who have very limited rights within the facility, this is a thing they choose to do and, if they're there for a long period of time, that they are being deprived of something that other people have as a right."

Psychiatric patients smoke at much higher rates than the general population, 75 percent compared with 22 percent, according to the mental-health directors' group.

Cooper said in some units of the state hospital, smoking rates approached 100 percent.

"One thing that would just break my heart was when people would say to me, 'I didn't smoke until I got here, and there was nothing else to do during the time when everyone was out there smoking,' " he said.

Other states have had difficulties banning smoking at their mental hospitals.

The Connecticut Valley Hospital's smoking ban has been delayed over a lawsuit filed by residents. A ban on smoking outdoors at New Jersey state psychiatric hospitals was signed into law a few months ago over strong objections by patients.

There are also problems with medications. Nicotine, a stimulant, interacts with psychotropic medication, and physicians may need to lower dosages after patients stop smoking.

Cooper said problems can arise if patients are released and again start smoking and their medication levels are too low.

Since the ban was put in place on July 1 at the Phoenix hospital, its implementation has been a work in progress for those confined to the facility.

The hospital serves about 300 people who have serious mental illnesses, including those sent there by the courts.

Residential-program specialist D.C. Foster said patients are adjusting.

"We have a few more hoops to jump through, but my guys now have more of a health-conscious focus about leading their lives now," he said.