Hospital Emergency Departments (EDs) are challenged by increasing numbers of people with mental health problems presenting with complex suicide or psychiatric risk. Social workers are often on the front line of initial assessment of persons in mental health crisis presenting to EDs. Many mental health patients are smokers and experience poorer health and mortality. Public health policy has seen hospitals become smoke-free, which poses challenges for managing the complexities of risk associated with mental health patients who smoke. ED clinical staff were randomly selected to anonymously complete a mixed method analysis questionnaire. Findings reveal participants regularly allowed cigarette breaks for mental health patients when considered safe to manage risk associated with difficult behaviors. Participants agree with the philosophy of hospitals being smoke-free, and would prefer to provide further education and support on smoking cessation to mental health patients. However, participants report barriers to this including being time limited, having limited resources, poor compliance from mental health patients, and citing that a personal crisis for the mental health patient is not an appropriate moment to enforce smoking bans. Further resources for staff and mental health patients are recommended if a blanket ban on smoking is to remain policy.