One in three people with mental health illnesses in the UK smoke, as compared with one in five of the general population. In addition, smokers with mental illnesses smoke more heavily, are more dependent on nicotine and are less likely to be given help to quit smoking. As a result, they are more likely to suffer from smoking-related diseases, and on average die 12-15 years earlier than the general population.
Since July 2008, mental health facilities in England have had indoor smoking bans. However, NICE guidelines recommend that all NHS sites, including psychiatric hospitals become completely smoke-free, a recommendation previously examined by the Mental Elf.
This NICE recommendation has been criticised by those who argue that:
- Tobacco provides necessary self-medication for the mentally ill;
- Smoking cessation interferes with recovery from mental illness;
- Smoking cessation is the lowest priority for those with mental illnesses;
- People with mental illnesses are not interested in quitting;
- People with mental illness cannot quit smoking.
Judith Prochaska, a researcher at Stanford University, has previously addressed each of these arguments (she calls them ‘myths’) (Prochaska, 2011). The abridged summary of the evidence surrounding myths 1, 2 and 3 is that:
- Smoking actually worsens mental health outcomes; in fact, the argument that nicotine provides self-medication is one which has been promoted by the tobacco industry itself;
- Smoking cessation does not exacerbate mental health outcomes;
- Smoking cessation should be a high priority, given that mental health patients are much more likely to die from tobacco-related disease than mental illness.
These are interesting and important arguments and more evidence surrounding them is also available here (Prochaska, 2010).
However, in this blog post I focus on ‘myths’ 4 and 5, drawing on a recent systematic review investigating the impact of a smoke-free psychiatric hospitalisation on patients’ motivations to quit (myth 4) and smoking behavior (myth 5) (Stockings et al., 2014).
Methods and results
Stockings and colleagues searched for studies examining changes in patients’ smoking-related behaviours, motivation and beliefs either during or following an admission to an adult inpatient psychiatric facility.
Study characteristics
Fourteen studies matched these inclusion criteria, two of which were conducted in the UK. The majority of the studies used a cross-sectional design and none were randomised controlled trials. The studies were all quite different, with the number of participants ranging from 15-467 and the length of admission ranging from 1-990 days. Crucially, the type of smoking ban varied considerably between the studies, so I’ll consider these separately.
Facilities with complete smoking bans
Six studies were conducted in facilities with complete bans. All of these offered nicotine dependence treatment, including nicotine replacement therapy (NRT) or brief advice.
- Only one of these statistically assessed smoking behaviour, finding that cigarette consumption was lower during admission compared with prior to admission.
- Three studies assessed smoking behaviour after discharge, finding that the majority of patients resumed smoking within five days. However, there was some evidence from the two larger studies that smoking prevalence was still lower at two weeks and three months post-discharge compared with prior to admission.
- The one study to statistically assess smoking-related beliefs and motivations found that patients expected to be more successful at quitting following discharge compared with at admission. Higher doses of NRT were related to higher expectations of success.
Facilities with incomplete bans
Eight studies were conducted in facilities with incomplete bans.
- Four banned smoking indoors and all of these offered nicotine dependence treatment:
- Only one of these statistically assessed smoking behaviour, finding that quit attempts increased from 2.2% when smoking was permitted in specific rooms, to 18.4% after the ban.
- One study that assessed smoking prevalence post-discharge found that all participants (n = 15) resumed smoking.
- One study found that participants expected to be more successful in smoking cessation post-discharge as compared with at admission.
- Three allowed smoking in designated rooms, with no nicotine dependence treatment:
- There were mixed results among the two studies which assessed smoking prevalence during admission.
- Compared with at admission, there was some evidence of increased motivation to quit smoking.
- One restricted smoking to five pre-determined intervals per day, with no nicotine dependence treatment:
- Motivation to quit was lower at discharge compared with at admission.
Conclusions
The authors concluded that:
Smoke-free psychiatric hospitalisation may have the potential to impact positively on patients’ smoking behaviours and on smoking-related motivation and beliefs.
Strengths and limitations
The fourteen studies included in this review were all quite different from each other and had a number of limitations including:
- Small sample sizes;
- Incomplete reporting of key outcomes;
- Failure to use controlled, experimental research designs;
- Differences in the types of smoking bans in place;
- Inconsistent provision of nicotine dependence treatment.
These key differences and limitations prevented statistical examination of the results as a whole. This means that making firm conclusions is difficult. There is clearly a need for more research in this area.
Summary
There is evidence that people with mental illnesses are interested in quitting smoking (myth 4) and that they are able to (myth 5). However, we still need more studies to examine these questions with well-powered (i.e. large sample sizes), high-quality (i.e., experimental) research designs.
The evidence presented in this systematic review suggests that complete bans are the most effective at encouraging smoking cessation and that the provision of nicotine dependence treatment, such as NRT or brief advice, is also crucial.
Although a handful of the studies assessed smoking behaviour after discharge, none of the facilities viewed this as an important outcome. Given the high level of smoking-related disease among those with mental health illnesses, ensuring that individuals remain abstinent from smoking after discharge is important for the continuing good health of these individuals.
Importantly, none of the studies in this review explored the impact of smoke-free legislation on mental health outcomes. Although the evidence suggests that smoking cessation actually improves mental health outcomes, future research should continue to examine this relationship.
Over to you
Do you have a mental health illness yourself, or support someone who does? Do you work with people with mental health illnesses? Should psychiatric hospitals become smoke-free?
Links
Primary paper
Stockings EA. et al (2014) The impact of a smoke-free psychiatric hospitalization on patient smoking outcomes: a systematic review. Aust NZ J Psychiatry 2014 May 12;48(7):617-633. [PubMed abstract]
Other references
Prochaska, J. J. (2010). Failure to treat tobacco use in mental health and addiction treatment settings: A form of harm reduction? Drug and Alcohol Dependence, 110(3), 177-182. doi: http://dx.doi.org/10.1016/j.drugalcdep.2010.03.002
Prochaska, J. J. (2011). Smoking and Mental Illness — Breaking the Link. New England Journal of Medicine, 365(3), 196-198. doi: doi:10.1056/NEJMp1105248
RT @Mental_Elf: The effect of smoke-free psychiatric hospitals on smoking behaviour: more evidence needed http://t.co/k3PJvDX4Bo
The effect of smoke-free psychiatric hospitals on smoking behaviour: more… http://t.co/Ct5S3cEVN0 #MentalHealth http://t.co/U0kombULBM
My new @Mental_Elf blog on smoking bans in psychiatric hospitals http://t.co/4LkPG253md
.@OliviaMaynard17 @Mental_Elf I am a psych patient. Had I been forced to stop smoking while in the hospital, I would have gone stark mad.
@OliviaMaynard17 @Mental_Elf you are one evil individual.
Here’s @OliviaMaynard17 writing for @Mental_Elf on smoking bans in inpatient settings – as ever, more research needed http://t.co/j2ZKZYt8yz
@Mental_Elf a bad time to force cessation and leads to overuse of sedative medications to calm patients that can’t consent to quit.
@drHelenschultz @Mental_Elf Inpatient D&A detox have the same. But they sneak them in. Given Nicotine patches & synthetic inhalers.
@EMS_Junkie @Mental_Elf I’ve just seen distressed nurses and more prn’s being used. What’s wrong with it being part of rehab plan?
@drHelenschultz @Mental_Elf Yep. Getting them off ice, THC & Etoh a challenge enough & medically a challenge. Cigarettes can come later
@EMS_Junkie @Mental_Elf totally. What is worse on their CV status? Overuse of antispsychotics to sedate or smoking in the short term?
@drHelenschultz @Mental_Elf Ive never given out so much Seroquel and Valium than my time in there!
@EMS_Junkie @Mental_Elf Well there you go. As if these meds don’t cause weight gain, CV side effects, insulin resistance etc etc…
@drHelenschultz @Mental_Elf I also learnt that crushed & smoked buscopan gives a “desired”high..Guess what they chart for withdrawal cramps!
Morning @Sectioned_ Interested in your thoughts on @OliviaMaynard17’s smoking ban blog today http://t.co/k3PJvEeFZY
@Mental_Elf very true. Good post. Ask the nurses on the ward how they feel.
The effect of smoke-free psychiatric hospitals on smoking behaviour: more evidence needed https://t.co/TMdRe4uGT9 via @Mental_Elf
New SR on the impact of smoke-free psychiatric hospitals on patients’ motivations to quit & smoking behaviour http://t.co/k3PJvEeFZY
The effect of smoke-free psychiatric hospitals on smoking behaviour: more evidence needed https://t.co/v3PHv6PJf9 @ShellyMun
Should we be forcing people to quit smoking when they are going through an acute mental health episode? http://t.co/k3PJvEeFZY
@Mental_Elf and take away they’re only coping strategy (especially if they’re an inpatient)
@Mental_Elf Question the #ethics of removing option of smoking for INVOLUNTARY patients. “Can not leave and by the way…..no smoking too”
@Mental_Elf For heaven’s sake -NO! Not the time for prissy rules. Can be addressed when person strong enough to consider ‘healthy lifestyle
@Mental_Elf @KayFSheldon I’ve known a few patients give up when inpatient. Their will power to do so is huge esp. with no patches etc 1/2
@Mental_Elf @KayFSheldon smoke breaks though are always contentious ipre timings & allotted period. Pers not in favour but have seen results
@Mental_Elf, @OliviaMaynard17: How does a “complete ban” EVER equate to “encouraging” smoking cessation? – #PatientChoice, not #CoercivePractice.
RT @Mental_Elf: Has your Mental Health Trust gone smoke-free? We’d love to hear your thoughts on this new evidence http://t.co/k3PJvEeFZY @…
Don’t miss: The effect of smoke-free psychiatric hospitals on smoking behaviour: more evidence needed http://t.co/k3PJvEeFZY #EBP
@Mental_Elf should the ref be Aust NZ J Psychiatry?
@Mental_Elf we’re working towards Smokefree at our local Trust but #ecigs are starting to be a popular option #early days
Compelling news for smoke free hospitals. http://t.co/LhMwXopf0i
Mental Elf: The effect of smoke-free psychiatric hospitals on smoking behaviour: more evidence needed http://t.co/X1HLoyBoep
It should be noted that voluntary patients are presenting for a particular mental condition. They are not presenting for smoking cessation. Involuntary patients are classified as such by a court order that requires them to undergo treatment for a particular mental condition. There is nothing in the court order about smoking cessation: Smoking is NOT why they have been classified as a mental patient. The facility is obliged to only treat the condition deemed by the court. It must also be remembered that involuntary mental health patients are not criminals.
If an involuntary patient is asking for a cigarette, they obviously don’t want to quit. Forcing smoking cessation on them is going beyond the scope of treatment permitted for the patient and violating informed consent (either patient or court). It’s bureaucrats and antismoking activist bigots terribly messing with vulnerable patients. Mental patients are not some experimental quantity whose entire lives are at the complete disposal/whim of psychiatrists/bureaucrats. There is very serious misconduct occurring here. The problem is that an ideological crusade – the smokefree “utopia” – now trumps the humane treatment of patients. It is a cruelty inflicting further distress and anguish on mental patients masqueraded as “duty of care”, i.e., iatrogenic.
Moreover, the “authorities” typically claim that patients are “treated” with “nicotine replacement therapy” (NRT) as if this makes their position any more tenable, that NRT somehow “solves everything”. In addition to the above concerns, NRT is next to useless for people without mental conditions that are wanting to quit smoking. NRT is entirely useless for those that do not want to quit, let alone that they might also be in a highly distressed mental state. Mental patients who smoke, already in a highly distressed state, are being forced to quit smoking “cold turkey”. This NRT “treatment” only generates sales for pharmaceutical companies. Why would anyone subject mental patients to this politically/financially-motivated assault? Why aren’t those in the mental health hierarchy aware that NRT is useless? Why do bureaucrats value the mental health of patients below maintaining an ideological (antismoking) stance? It is those running mental health facilities that are demonstrating some serious mental issues. And it wouldn’t be the first time that mental health authorities have used/exploited mental patients in a malicious and criminal manner; the provision of treatment for mental patients is littered with dark periods where the obscene conduct of the “healers” defies sane description.
In chasing a questionable ideological agenda, a cruel streak has again been allowed to proliferate within the mental health hierarchy; it’s another “dark” period. A mental patient that smokes is now confronted with a perverse, frightening, and destructive cult mentality in the health system that is fanatically intent on forcibly “converting” the patient into a nonsmoker. It is entirely beyond the scope of necessary/mandated treatment that further compromises the mental health of patients. This obscene situation is in urgent need of scrutiny, asking how an ideological agenda has been allowed to derail the humane and legal provision of mental health services.
As someone who has worked in mental health services (acute wards and day services) over the last 27 years, I agree wholeheartedly with this assessment of enforced smoking cessation & restriction for people using mental health services, especially when they are subject to legally enforced incarceration.
This in itself is difficult enough, but generally accepted as a necessary evil to protect the individual and others while experiencing a mental health crisis, but it must be remembered that they are not criminals on whom the state can impose freedoms that the individual chose to risk when committing a crime (whether enforced cessation is admissible there is another debate), but they are people who are ill and no freedom should be unnecessarily removed.
Removing reedom of movement, of free association & freedom to refuse treatment for their mental health condition is restriction enough.
Refusing access to cigarettes as & when required is beyond the remit of the legal purpose of the section and is morally reprehensible.
Of course concerned individuals want to address the health inequalities within mental health, but this should be offered as a choice, not forcibly imposed on people at the mercy of public health zealots.
Myth busting the effect of smoke-free mental health facilities. #HLT301 http://t.co/iCyC0FAh8h
A close relative of mine suffers with major depression and smoking is a positive vice for him and helps him contain this. He also enjoys such activity. He was sectioned in 2011 before such smoking bans. If he were to ever be sectioned in the future, I would be extremely concerned for his perceived ability to cope and function with hypothetical deteriorating mental health as well as being told that he would be unable to smoke on the premises. I think we all have our vices and it is good that hospitals are promoting such a topic; albeit, equally don’t kick a man whilst he’s already down – make designated smoking rooms mandatory as this is an enormous coping mechanism, distraction and social support for many people – with and without mental health problems. It is good to promote such a behaviour in young people – the age at which most people start, but for people like my relative who have chosen to do it for many years and enjoy doing it shouldn’t be punished for their chosen behaviour if and when they require medical attention for their mental health. This is probably a bit too much the other way but it is like taking a bin out of a doctor’s surgery waiting room – unhelpful and unnecessary for a lot of people.
It’s America that’s popularized antismoking insanity – again, and which other countries are following suit. Most are staggeringly still not familiar with this history. America has a terrible history with this sort of “health” fanaticism/zealotry/extremism or “clean living” hysteria – including antismoking – that goes back more than a century.
Antismoking is not new. It has a long, sordid – even violent, 400+ year history, much of it predating even the pretense of a scientific basis or the more recent concoction of secondhand smoke “danger”. Antismoking crusades typically run on inflammatory propaganda, i.e., lies, in order to get law-makers to institute bans. Statistics and causal attribution galore are conjured. The current antismoking rhetoric has all been heard before. All it produces is irrational fear and hatred, discord, enmity, animosity, social division, oppression, and bigotry. When supported by the State, zealots/prohibitionists seriously mess with people’s minds on a mass scale.
For a brief history of antismoking, see:
“Cigarette Wars: The ‘Triumph’ of the Little White Slaver” (1998) by Cassandra Tate. Google the following combination – “the endless war on tobacco” “seattletimes” – which should bring up a summary article of the book at the Seattle Times.
Gordon L. Dillow (1981), “Thank You for Not Smoking” [The Hundred-Year War Against the Cigarette]
Robert Proctor (1996), “The anti-tobacco campaign of the N#zis: a little known aspect of public health in Germany, 1933-45”
Mental health professionals should really start taking a long, hard look at the damage that Public Health is doing to mental and social health generally through its ideological (e.g., antismoking) “crusades”. The following is just a sample of vile, vulgar antismoking comments that an author has collected over the last few years while on the internet:
https://www.dropbox.com/s/hzc1cuv6wknzrjh/MasterHateFINALC45x30%20%28Custom%29.jpg
The US of A has a long history of anti-tobacco (part of “clean living” hysteria) that goes back to the mid-1800s. Anti-tobacco was latched onto by Temperance (religious) groups and assorted physicians. All manner of [baseless] claims were made about the “harms” of tobacco. Within the hysterical fervor to “save” the “slaves to tobacco”, it produced a (moral) pressure to quit (or not start) not unlike we currently see.
Below are some of the snake oil “cures” offered in America. They’re all from the mid-1800s to early-1900s.
“Narcoti-Cure” 1895.
“Coca Bola”
“Hindoo”
“No-To-Bac” (Sterling Remedy Co.) late-1800s
“Tobacco Redeemer” (Newell Pharmacal)
“Baco Curo” late-1800s
Then there was Ballou’s “Tobacco Disinclinator” from 1867
Interestingly it made these claims, without basis, back in 1867:
“That the use of Tobacco shortens human life from Five to Twenty years, decreases manly vigor in the same ratio, causes a majority of the sudden deaths attributed to heart disease, and renders the subject more susceptible and less able to withstand any disease, is the opinion of our most eminent physicians. How shall we rid ourselves of this accursed habit, and prevent the uninitiated from falling into it? …..”
http://www.loc.gov/pictures/resource/cph.3c02485/
Sounds exactly like contemporary antismoking! And there’s the standard prohibitionist slogan that we constantly hear today – “How shall we rid ourselves of this accursed habit, and prevent the uninitiated from falling into it?”
“Nicotine replacement therapy” is the current snake oil treatment.
So violence and brutality are a thing of the past? We NOW have bloodthirsty murderers that are also rabid antismoking activists (one of the few agendas adopted from the West), instituting a complete (everywhere) ban on smoking with brutal fervor ….. for the “good” (at gunpoint) of their captives, of course…. for a “healthy” society:
http://dailycaller.com/2014/06/13/jihadi-militants-ban-smoking-and-guns-in-conquered-territories/#ixzz34cdxaMGD
http://www.mirror.co.uk/news/world-news/isis-thugs-viciously-beat-cowering-5722162
The bonfire disposal of cigarettes is a nice tyrannical touch. And it’s not an isolated incident. There are similar bans and bonfires (and guns) in Africa.
Antismoking is “anti”; it’s an extreme, prohibitionist view. It’s always a symptom of a dictatorial mindset. The only issue then is the magnitude of coercive measures. With ISIS, a brutal, savage bunch, people are ordered not to smoke under threat of having fingers and ears lopped off, if not worse. In the less brutal West, for example, the punitive measures are more “civilized”, consisting of inflammatory propaganda concerning the “risks” of smoking and secondary smoke to nonsmokers, pitting a majority against a minority, ostracize/de-normalize smoking/smokers from normal, mainstream society, smoking bans galore – indoors and out, the depiction of smokers as a “leper” class that contaminate the “clean”, and fleecing smokers through baseless, extortionate taxes.
Antismoking brutality and violence a thing of the past? We NOW have bloodthirsty murderers that are also rabid antismoking activists (one of the few agendas adopted from the West that’s otherwise despised), instituting a complete (everywhere) ban on smoking with brutal fervor ….. for the “good” (at gunpoint) of their captives, of course…. for a “healthy” society:
http://dailycaller.com/2014/06/13/jihadi-militants-ban-smoking-and-guns-in-conquered-territories/#ixzz34cdxaMGD
The bonfire disposal of cigarettes is a nice tyrannical touch. And it’s not an isolated incident. There are similar bans and bonfires (and guns) in Africa.
Antismoking is “anti”; it’s an extreme, prohibitionist view. It’s always a symptom of a dictatorial mindset. The only issue then is the magnitude of coercive measures. With ISIS, a brutal, savage bunch, people are ordered not to smoke under threat of having fingers and ears lopped off, if not worse. In the less brutal West, for example, the punitive measures are more “civilized”, consisting of inflammatory propaganda concerning the “risks” of smoking and secondary smoke to nonsmokers, pitting a majority against a minority, ostracize/de-normalize smoking/smokers from normal, mainstream society, smoking bans galore – indoors and out, the depiction of smokers as a “leper” class that contaminate the “clean”, and fleecing smokers through baseless, extortionate taxes.
I took part in a medical study as part of the control group, who were required to be smokers, as the group being studied (schizophrenics) were all smokers. I was told by the lead researcher that over 80% of schizophrenics. He said it was partly self-medication – it helps them cope with their illness; and also to lessen the bad side effects of their medication. A smoking ban for people voluntarily admitted to mental hospitals will make them less likely to get medical help. Any smoker will confirm this. Banning those who are sectioned, so effectively imprisoned, from smoking, is purely barbaric and I’m very surprised it is not illegal.
In the current antismoking hysteria it’s fashionable to ban smoking not only in hospital buildings but on the entire hospital premises (i.e., including all outdoor areas). If patients, staff, or visitors want to smoke, they are expected (as their punishment) to walk, possibly in their night attire, considerable distances, in any weather, onto perimeter streets. Understandably, these draconian “rules” are flouted. One would think that at some point someone in the medical administration would say, “I think we’ve pushed this antismoking a little too far. Let’s ease off”. Not so. Quite the opposite. There’s one hospital that’s now pushing not only for fines but for up to £1,000 fines for “offenders”. The antismoking becomes even more draconian.
http://www.edinburghnews.scotsman.com/news/health/hospital-fines-for-smokers-flouting-ban-1-3764219
Surely there must be at least some, particularly in metal health services, that can tell that this antismoking thing is completely out of control. If we want to consider hostility, violence, neuroses (capnophobia, somatization), megalomania, cruelty, bullying, a “god complex” – antismoking has it all. Why has this considerable mental dysfunction been allowed to flourish? How has it been allowed to flourish as “health” promotion?
For those not familiar. The current antismoking crusade, very much in the eugenics tradition – involving the same medically-aligned personnel and repugnant methodology, is much like crusades over the previous 400 years. It is a moralizing, social-engineering, eradication/prohibition crusade decided upon in the 1970s by a small, self-installed clique of [medically-oriented] fanatics operating under the auspices of the World Health Organization and sponsored by the American Cancer Society (see the Godber Blueprint http://www.rampant-antismoking.com ). This little, unelected group, using much the same inflammatory rhetoric of its fanatical predecessors, decided for everyone that tobacco-use should be eradicated from the world – for a “better” (according to them) world. These fanatics were speaking of secondhand smoke “danger” and advocating indoor and OUTDOOR smoking bans years before the first study on SHS, and extortionate taxes on tobacco years before contrived “cost burden” analyses of smoking: In the 1970s, populations – particularly in relatively free societies – weren’t interested in elitist social-engineering, particularly by a group (medically-aligned) that had a horrible recent track record (eugenics). Given that their antismoking crusade would have otherwise stalled, the zealots conjured secondhand smoke “danger” to advance the social-engineering agenda, i.e., inflammatory propaganda. Until only recently the zealots claimed they weren’t doing social engineering, that they weren’t moralizing. Well, that’s a lie that’s been told many times over during the last few decades.
Olivia, if you’re going to quote Prochaska, you need some background. Prochaska is an adjunct professor at the University of California (San Francisco). UCSF is antismoking (prohibition) central. The person who runs the Tobacco Control center at UCSF is Stanton Glantz. He’s been with the current antismoking crusade from its beginnings in the 1970s. He is a typical, rabid prohibitionist. He’s published hundreds of research papers, many in fields in which he has no postgraduate qualifications (e.g., economic consequences of smoking bans in the hospitality sector). And, guess what? They all arrive at antismoking conclusions.
“A woman was hit in the head with an ice skate in an unprovoked attack because she was smoking, a court heard.”
http://www.dailypost.co.uk/news/north-wales-news/mold-crown-court-hears-woman-9273919
Smoking bans in entire apartment complexes (including outdoors) are gaining momentum, particularly in the USA. It’s a recent phenomenon. They’re even banning smoking in apartments in such places where it gets lethally cold during winter, e.g., Alaska. Smokers are advised that they must go outside (onto perimeter streets) in the freezing cold if they want a cigarette or face eviction.
The elderly/disabled, in particular, are being harangued and harassed. I’ll provide one example although others can be provided.
“The story of 97-year-old, Jane O’Grady”
http://www.wptv.com/dpp/news/region_indian_river_county/vero_beach/jane-ogrady-97-in-jeopardy-of-eviction-from-lakes-at-pointe-west-home-because-of-smoking-habit
Smoking and nicotine use can be separated, I’m sure you are aware. I would encourage you to take a look at this objective overview http://www.ijhpr.org/content/pdf/s13584-015-0021-z.pdf
Then reflect.
Those who seek to turn centres of healing and refuge into places for behavioural correction are in my view evil. There is no excuse for their vileness and I resent paying for them.
“Smoke-free psychiatric hospitalisation may have the potential to impact positively on patients’ smoking behaviours….”
It will obviously stop them from smoking, but at what cost to their general health and well-being. For example, many will then avoid being admitted to a psychiatric hospital. I discharged myself from a hospital (not psychiatric) because of the smoking ban. I was shocked at the risk I was prepared to take. Thankfully, no harm was done – and I saved the NHS a fair amount of money.
Blog by @Mental_Elf on smoking cessation in mental health hospitals. I’m absolutely for smoking bans – they’re parity http://t.co/qNlKitRT2e
#Roken in #psychiatrie: stoppen?
Effect smoke-free psych hospitals on smoking behaviour: http://t.co/A4ntkMIAuc @Mental_Elf @PsychiatrySHO
I’d argue there is a point 6: Human Rights Grounds.
People who reside in mental hospitals are deprived of their liberty as such have to remain on hospital grounds. As such, provision should be made for them to make the same lifestyle choices as anyone else. For them, the hospital is ‘home’ as such banning it contravenes their human rights. Especially as there is no evidence that ‘smoking’ is a contributory factor towards their detention.
Its disgraceful treating patients as if they are too stupid to make their own decision whether to smoke or not.
[…] http://www.nationalelfservice.net/publication-types/systematic-review/the-effect-of-smoke-free-psych… […]
[…] week the Mental Elf reviewed a research paper on the effects of smoke-free policies in psychiatric hospitals. It looks like some smokers manage […]
We are about to introduce smoke free environments across our mental health care and supported living homes. We would be very interested to being able to research the impact if someone wishes to help us.
I am not a smoker but I think it is disgraceful to treat mental patients as idiots. How dare people force patients to stop smoking. Prisoners can smoke. But mental health patients are treated like children ,being told they have no rights because they are patients. absolutely disgraceful behavior. How dare you. Who do you think you are.
Interesting couple of comments posted here: https://lypftplanningcare.wordpress.com/2015/05/28/smoking-in-psychiatric-hospitals/#comments
I’m currently an in patient and do not smoke.
I experience discrimination because I do not smoke in that I am obliged to smoke passively if I want to benefit from the communal areas.
I deeply resent this. I keep asking to see the Hospital’s smoking policy (it is part of the Cambian Group) but they are reluctant to show it to me.
I have been in a hospital where smoking was not allowed and the whole environment was much more positive – much more conducive to good mental health.
Here, where smoking is allowed, it seems that all patients are interested in doing is marking the day with cigarettes smoked – with precious little interest in anything else. And of course the petty dramas revolving around patients trading cigarettes or ‘bullying’ others into handing them out creates for an unhappy ward.
I cannot believe that in this day and age that the rights of smokers should come before those of non-smokers.
As you can tell I am deeply unhappy about this situation and any suggestions posters might have as to how I might oblige the Cambian Group to support me in not smoking at least on equal standing with their enablement of patients who do smoke, will be greatly appreciated.
[…] blog originally appeared on the Mental Elf site on 18th May […]
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I’m hoping people are still reading and commenting on this post – I am enjoying the debate.
I’ll begin by saying that I thought I was 100% opposed to the smoking ban, as I want people to have personal freedom. However, on reflection, I probably do agree that it is a positive thing that things like alcohol and cocaine are also banned. This of course flies in the face of my logic for disagreeing with the smoking ban – using alcohol or drugs is also a personal freedom. Perhaps I could just about stretch to accepting a ban on drugs, as they are illegal (even though I disagree with this law). But why do I agree with an alcohol ban and not one on smoking?
Has anyone else had thoughts like this?
[…] blog originally appeared on the Mental Elf site on 26th August […]
I lost 3 close relatives in the space of 6 months, as a result I ended up severely depressed and walked out of my job. Tobacco was my only vice and helped me cope. The anti-depressants plied by the doc only lead to lethargy, weight gain (carb binging is a side effect). On a number of occasions I was suicidal and if I ended up in the care of a regime like this I would have topped myself
I can only describe this policy as miserable wretched and torturing
Most smokers become nicotine dependent. Social factors also play a part in keeping smokers smoking. As a result of high smoking rates, people with a mental health disorder also have high mortality rates compared to the general population. So please quit to smoking.
Load of rubbish. When unwell, I smoke more to get me thru bad anxiety, depression. If I recognized I was becoming unwell with bipolar and psychotic episodes, I would not seek help as I will not go to a unit. I accept this puts me as being potentially at risk and others around me. Don’t care, I enjoy smoking and if it helps calm.a situation then so be it. If I was stopped, I.know I would kick.off and my.behaviour would become threatening.
More nhs crap to draw away people’s attention to the under funding in mental health services. The so called hierarchy that impose these bans should try be sectioned on a unit for several weeks/months to realize certain.units make your condition worse not better due to lack of something to do to try to divert and motivate thought/avtion processes. Makes me sick
How about focusing on mental health and let the primary physician focus on physical health to stop smoking. I believe in Behavior modification it shows that just imposing a ban often does nothing except as soon as out of that environment or ban the behavior will began again. The person has to want to quit, just like in other addictions. You have read about the study where college students become the guards. You do not need to police every behavior when your focus should be on mental health, unless the patient ASKS for help in quitting.
My sons biggest problem to recovering is not being allowed to smoke and then being punished if he does manage to get one in the grounds by not being allowed out for days at a time. His mood is worse than when he was admitted almost 4 months ago!
is it a breach of basic human right to enforce the smoking ban whilst detained under section 2 of the mental health act? By this i dont mean within the hospital itself but in the gardens or surrounding area.
This is what I observe in the mental health rehab ward where my son is currently sectioned:
1) The ward has a comparatively lax policy on smoking. Patients can smoke just outside the ward in the hospital grounds. This is apparently due to change soon.
2) Detained patients need to be accompanied. In practice, this means two smokes a day if the patient is persistent and lucky. There will almost always be a wait.
3) Smokers do keep their tobacco and lighters with them when they can. They do smoke within their bedrooms and sometimes get caught.
4) There is quite a developed smoking culture amongst patients within the ward. They share tobacco and lighters, especially lighters. Everyone knows who has a lighter and lighters are willingly shared. Patients don’t grass when they get caught with somebody else’s tobacco or lighter, and they apologise to the lighter owner for losing it.
5) There is something very positive about these social interactions, even though they are about smoking. It brings patients closer together.
6) Yesterday, I witnessed a female patient being searched after she had been caught for the second time in an hour smoking in her room. The search wasn’t violent or unnecessarily aggressive, three staff were in attendance, it looked like correct procedures were followed.
7) Equally, the search process was horrible to witness and to experience. It was like the patient had committed a crime.
8) I would have thought that it would be heard for research studies to include this sort of smoking
9) None of the smokers on this ward seem to have any commitment to giving up smoking.
I believe that an outright ban on smoking on NHS wards is both fascist and very cruel. I was recently incarcerated (against my wishes) in one of these places and the hourly smoke break was the highlight of the day (approximately 95% of patients on every psychiatric ward I have been on smoke). I stopped smoking 6 years ago but start again every time I am readmitted as I find nothing in life is as stressful as being locked up on a psychiatric ward. I stopped smoking again when I got discharged. And I think that if I had been unable to smoke as an inpatient I would have become very agitated and possibly violent (I am not a violent person.). It is known that nicotine has a calming effect (and, in my experience, it works). I should also add that there is nothing else to do on these tiny contained ward’s- apart from try and watch TV (amongst all the disturbances). I also think it is unethical to deprive someone of their right to smoke – which they would be allowed to do if they hasn’t been deprived of their liberty by the cruel and inhumane system that is psychiatry. I believe a blanket ban is coming in next month (April 2018). I think this is horrendous – the nanny state as Big Brother.
The smoking ban in the hospital I worked In, increased the violence and aggression from Patcients against staff. More protests. When people come in voluntarily they have the right to leave to smoke, but when they become more unwell, they are then put on a section and loose that rigjt. However most patcients smoke in their rooms and all sorts of things like drugs are making their way in to the hospital as the patients know that they can get away with it as it is too risky for staff to challenge them on their own and there are not enough staff to go round in pairs to do it every time a patient lights up. Staff are split over it too. Not because of the common arguments over it being bad for your health etc but because it is too dangerous for them to risk being punched in the face over some one lighting up who they wont let out too smoke and staff dont see the point in putting their efforts in to it as they know that patient will find cigarettes tobbaco and lighters from some other patcientsb in the hospital who can come and go as voluntary Patcients . Protests can rage from trying to climb up on to the roof to setting fires to their rooms. It doesn’t help anybody the rewards don’t balance against the sacrifice to the service we are supposed to be giving. These mental health units are supposed to he places of safety. It is wrong to enforce a ban against smokers in these units. They are forced to take medication that has side effects of shortening their lives they are not there to be treated for smoking. Smoking is not a mental illness. But they are not being allowed to do that. And many of them are allready or have allready attempted to shorten their lives by making attempts on their their lives. That is the irony and why the NHS, NICE can not take the higher ground on saying this ban should be enforced.This ban was enforced because a Patcient took a trust to court and lost, by saying it was her human right to smoke and it was filled that the human rights act , does not recognise smoking as a human right. But it should recognise the right to l8ve without fear or persecution for so many staff and patients under this ban