The Mental Health Foundation has this month published the results of a survey which suggests the ban on smoking in inpatient units has been highly problematic, and has lead to ‘secret smoking’. You can read the full report here on the Mental Health Foundation website.
I began working as a CPN when the ban was introduced – and, certainly initially, I felt very sorry for the colleagues I had left on the PICU of a Regional Secure unit who had to tell patients with very limited access to outside that they were forbidden to smoke. I am not a smoker, however I can imagine that if I smoked and found myself in very distressing circumstances, and in an unfamiliar environment, I would find smoking a source of comfort and reassurance.
The Mental Health Foundation report suggests that attempts to ban smoking are simply driving the habit underground. They found that only a minority of wards in England have introduced the ban successfully. 85% of 109 respondents to the survey said the ban, which came into effect in July 2008, had not been implemented effectively. The rise of “secret smoking” has lead to safety concerns: the risk of fire, and also the risk that patients who are very unwell may become aggressive to staff when told they may not smoke.
Members of staff are reportedly unhappy to take on an additional policing role, when they are already faced with the problems of holding people against their will and persuading them to take medication. Some staff members said they felt they had no choice but to break the law and ‘turn a blind eye’ to smoking, especially when patients were acutely unwell, and in units which lack an appropriate outdoor space to allow people to smoke. The ban was also felt to be a drain on resources as staff members were needed to escort patients off the unit to smoke.
There are questions that need to be asked about the effect the ban has had on the wellbeing of patients. Whilst it may be the case that a smoke-free environment is a healthier one in terms of the physical effects of smoke, Vicki Nash, of the mental health charity Mind, said: “Forcing people to stop smoking abruptly on admission to hospital when they are already likely to be distressed is inappropriate and could heighten anxiety”. According to Mind, people with mental health problems are twice as likely to smoke as the general population – which means that this ban is very difficult for a high proportion of patients.
Despite all of this the government’s mental health tsar said he had visited many trusts where a ban had been smoothly implemented. Louis Appleby, the National Director for Mental Health, said other research had shown that although implementing the smoking ban had posed challenges, most trusts believed it had been done successfully. Professor Appleby said: “I have visited many trusts who have implemented the ban with little or no difficulty. Mental health wards are being transformed for the better and going smoke-free is part of this. We believe that mental health staff and patients deserve the same healthier, smoke free environment as the rest of the NHS and there are no plans to change the policy.”
Hospital or Prison?
Prison inmates are allowed to smoke in their cells, as prison is classed as a ‘home’. Does it seems odd that there is greater freedom in prison that in a mental health setting? May be not! Prison inmates also have the right to refuse medication.
On July 28th 2008 there was a nine hour rooftop protest at Ashworth Hospital in response to the smoking ban. The Liverpool Echo reported that an Ashworth source said: “It just went cold turkey on July 1. After that it was no smoking for anyone anywhere on the premises. We’ve got lags coming in who are used to prison life and have that prison mentality, and now they have lighters and cigarettes confiscated when they come through these doors. They don’t like it and you could see trouble had been brewing because they didn’t take kindly to it. We’ve been waiting for something like this to happen.”
I’m not sure I would take kindly to the smoking ban either if I had been admitted to hospital from my own home. Even if I wanted to give up smoking I am not sure that the day of my admission to a psychiatric hospital would be the best time!
What do you think?
Pictures from Flickr (click images to see more from these photographers)
1. by get down
2. by Penseri
3. by Mot