‘Public Health’ Tyrants Are Taking Over The Asylum

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Credit: “Addiction” by Danilin, FreeDigitalPhotos.net

An unholy alliance of quangos with an authoritarian agenda, are riding roughshod over the will of patients, doctors and nurses in demanding a total ban on smoking in psychiatric hospitals.

As of June 2015, 9% of psychiatric hospitals have banned smoking both inside and outside.  83% of units only permit smoking outside.  63% prohibit e-cigarettes.  Public Health England (PHE), sponsored by the Department of Health, and with the backing of the National Institute for Health and Care Excellence (NICE), are pressing for 100% ban, inside and outside.

PHE believes the lower life expectancy of all smokers is a “health inequality” to tackle.  PHE hates anyone smoking, but with mental health in-patients, they have discovered some easy targets.  These people are atomised, captive, and distressed, often lacking the ability and means to rebel.  In ‘Smoking Cessation in Secure Mental Health Settings: Guidance for Commissioners’, PHE menacingly says “admission to a secure mental health unit can be an opportunity to intervene” (p.4) and re-informs staff how to do their jobs properly, including that they stop smoking themselves (p.22-23).

There are many reasons to oppose the ban.  It deters smokers from seeking voluntary assessment if they are developing mental illness since treatment appears unbearable.  Secondly, smoking is a comfort for troubled people who are at their most distressed and vulnerable.  Taking this freedom away is cruel.  Thirdly, a ban creates conflict between patient and staff at a time when the patient urgently needs to somehow trust those who are detaining them.  Without that trust, the chances of recovery are severely impaired.  Fourthly an asylum is a place to get mentally well, they shouldn’t promote physical fitness over and above that goal.  Fifthly a ban is horribly illiberal because the ward becomes one’s living quarters – it’s like saying you can’t smoke in your own home.  For more on these common-sense objections, see my article here.

Some say that smoking harms other non-smoking patients.  But this isn’t true in a hospital if smoking was only permitted in a designated room, or outside – non-smokers are already protected.  Furthermore, the potential for violence if a nurse confiscates a patient’s cigarettes could undermine the harmony and smooth running of a good psychiatric clinic, freaking out observing non-smokers as well.  Smoking bans represent turmoil for all patients and staff.

PHE’s intervention has not yet been widely discussed in society as the ban is bypassing Parliamentary debate.  Sadly when it was reported by BBC News, they misleadingly said that smoking reduces the effectiveness of mental health medication by up to 50%.  Rightly we don’t permit the use of illegal drugs or alcohol in asylums because they certainly do interfere with good medicine.  Policies like bag searches, room searches, monitoring and surveillance, even breathalysing, take place in clinics to enforce this.  If tobacco did interfere with medication, it would be a strong argument for restriction.  But it’s a bluff.

The source of the BBC’s claim was a PHE quotation that said, “doses of affected drugs can be lowered, sometimes by as much as 50%” if a patient ceases smoking (p.10).  This was based on evidence from the Royal College of Physicians and the Royal College of Psychiatrists (RCP, 5.4.4).  But nowhere it suggests that psychotropic drugs are ineffective in smokers.  Anti-psychotics are just as effective in smokers as in non-smokers, it is just that sometimes the frequency of dosage has to be increased as polycyclic aromatic hydrocarbons (PAHs) in tobacco (not the nicotine) increase the rate at which the medicine is metabolised by the body.

PHE think increased frequency of dosage is a problem because they state it costs £40m extra per year when they want to make savings.  But this bean-counting approach is irrational because the NHS mental health budget is £32bn per year – saving only £40m won’t lead to a new golden age of wealth in the system.  Furthermore, as the RCP report says (8.5), the real world financial saving may only be £12m if generic anti-psychotics are deployed.

Also e-cigarettes don’t contain PAHs (an organic compound) yet are also viewed negatively, suggesting the objection to smoking is moralistic rather than scientific.

Two thirds of in-patients smoke, up to 88% for psychosis sufferers, because tobacco is a form of self-medication.  Schizophrenics suffer extreme cognitive impairment around abilities such as learning, memory, and attention.  Tobacco helps these areas in sufferers.

Similarly with depression, cigarette smoking mimics effects of antidepressant drugs.  Whilst tobacco is not a medium or long-term solution, all smokers will attest that smoking reduces anger and stress in the immediate short-term.  As the majority of mental health patients are only staying in hospital briefly, smoking is helpful.  If you are treating someone for depression or anxiety, the one thing that’s guaranteed to make them more depressed or anxious is to take away their cigarettes!  Advice is one thing, but a blanket ban is quite another.

Smoking is not just chemical relief, but helps build up a trusting relationship with staff who obtain your tobacco for good behaviour.  Smashing this apart is not good clinical practice.  PHE believe that smoking breaks could be replaced with other “healthy therapeutic activities” that can repair the breakdown in trust they have caused.  Simon Bristow, Islington’s ‘Smoking Cessation Chief’ said, “We are increasing activities like dance to fill the void”.  Maybe all patients should sing “If you’re happy and you know it, clap your hands”.

PHE bizarrely claim their policy promotes choice because patients would like to quit smoking at the same rate as wider society.  Certainly if the individual wants help to quit, all available support should be given.  But a blanket ban will also target those who don’t want to give up.  It’s not choice then, it’s coercion.  ‘Empowering the patient’ really means ‘all power to PHE’.

PHE says, “There is a need to see health and not mental health…as a key institutional goal” (p.10), twisting the service into promoting morally virtuous lifestyles rather than treating specific illnesses. This represents the colonisation of what should be a kind-hearted service by bumbling busybodies preaching moral scripture over respecting autonomy and staff’s frontline experience.
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4 thoughts on “‘Public Health’ Tyrants Are Taking Over The Asylum

  1. 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.

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