Why Do MIND Want To Force Psychiatric Patients To Give Up Smoking In The Middle Of A Mental Breakdown?

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Here is an email from the mental health charity MIND explaining why they won’t oppose the banning of outdoor smoking in mental health facilities, and why they support forcing psychiatric patients to give up smoking when they are in the middle of a mental breakdown.  My response is below this letter.

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Hi Barry,

Thank you very much for getting in touch about the smoking ban in mental health hospitals and we are sorry for the delay in responding to you.

 This is a challenging and difficult area and one that we have recently given great thought.

 We are aware of the challenges that the smoking ban can cause to people in mental health hospitals – we understand, like you point out, that many people who smoke while staying in mental health units do so to pass the time or to socialise, and that quitting when someone is experiencing poor mental health will be challenging. We do, however, support the move towards completely smoke free mental health settings due to the evidence for the physical and mental health benefits for service users – people with mental health problems, for example, die on average 10-20 years earlier than the general population, and smoking has been found to be the biggest reason for this inequality.

Due to the challenges that the smoking ban will cause, it is vitally important that any moves to go smoke free are done in conjunction with tailored stop smoking support and address the reasons why people may be smoking while in a mental health setting. We would not support a hospital’s decision to ensure an individual gives up, without the necessary support and we also ask hospitals to develop alternative recreational facilities and opportunities to socialise.

 I’m sorry if this was not the response that you were hoping for – this is clearly an area that you are particularly passionate about and we wish you all the best for the future.

 Take care,

 Alec

Alec Williams
Policy and Campaigns Assistant

(Mental Health Services)

Mind
15-19 Broadway, Stratford, London E15 4BQ
w: www.mind.org.uk
Registered charity number 219830. Registered in England number 424348.

 

Dear Alec,

Thankyou for your response. On behalf of CASBIPU (The Campaign Against Smoking Bans In Psychiatric Units), I would urge MIND to reconsider their position. MIND is supposed to be a charity that advocates patient’s interests and rights, yet now you are riding roughshod over this. After a debate at the Institute of Psychiatry, King’s College London on 11 November 2015, where all the arguments for and against were heard, an online poll found that 72% of respondents were against the bans, only 28% for them. So you do not have democracy on your side.

You trot out the statistic often used by the powerful ‘public health’ lobby that SMI sufferers die on average 10-20 years earlier than the general population, and blame all this on smoking. The statistic needs interrogating. Smoking is no more physically harmful to an SMI sufferer than it is for a ‘normal’ person (and indeed carries some health benefits in terms of metabolising medication, mitigating side effects of both the medication and the illness, and improving happiness).  The evidence on the physical harm of smoking for all people is clear: if you persist in smoking 20 or more cigarettes per day beyond the age of 40, then your mean average life expectancy decreases by 10 years. This is a mean average, it doesn’t apply to everyone. So smoking beyond the age of 40 is certainly a health gamble – you might die younger, you might not. All smokers these days are aware of the gamble and think the risk is worth taking for the role played by tobacco in enriching their lives. You may disagree with their choice, but it isn’t always irrational. This is even more so with SMI sufferers whose lives are generally more miserable than the general population’s (they may have difficulty holding down a job or forming relationships due to their condition, so choose to smoke). Even if they do smoke, they are taking the same gamble as the average smoker – a potentially shortened life expectancy of 10 years for the sake of happiness in the here and now. This is not an irrational choice, and it is theirs to make, regardless of whether you disagree with it. To deny SMI sufferers this choice is to discriminate against them, based on the prejudice that they are unable to make rational choices and thus do not qualify for having rights. That is tyranny.

So if smoking only accounts for an average 10 year depletion of life expectancy in SMI sufferers, why do some appear to die on average 20 years younger? The answer is not mysterious. The statistic was concocted by finding a mean average for the mortality across all SMI sufferers. Thus someone who commits suicide in their 20s was equated with an SMI sufferer who dies in their 90s. The ‘middle point’ that was found is therefore misleading, as like is not being compared with like – the two cases are very different. Furthermore, more light is shone on the statistic if one bears in mind that SMI sufferers generally have worse access to physical healthcare (due to socio-economic factors or idiosyncratic factors emanating from their condition such as fear of doctors or drug and alcohol abuse). It is an extremely vulgar analysis to pin the entire blame on smoking.

CASBIPU believes smoking bans in psychiatric units are actually dangerous to patients in three ways:

1) They are dangerous to the culture of the ward. Since the UK indoor ban came in, cases of self-harm have gone up by 56% as the removal of this freedom and the predictable failure of distracting yogic flying therapies or whatever has lead to a deterioration in one’s quality of stay. In the USA where outdoor bans now exist in state-run hospitals in 35 out of 50 states, patient-on-patient violence has increased by 22%, and up to a whopping 170% in Austin, Texas, as patients no longer have a shared interest or social life, so have turned against each other. Furthermore the evidence from the USA suggests that average durations of detention have increased by nearly 90% since the smoking bans came in.

2) They are physically dangerous to the health of the patient. In an article in the journal Current Psychiatry, abrupt smoking cessation is linked to a wide range of health problems, including worsening psychiatric symptoms. Note that NRTs including e-cigarettes are absolutely useless in mitigating the disastrous effects of abrupt smoking cessation since it is the polycyclic aromatic hydrocarbons in tobacco, not the nicotine, that is physically stabilising.

3) They are therapeutically dangerous to the mental health of the patient. In a perceptive article for the BMJ, a retired GP observes that smoking bans undermine the autonomy of the patient, something that is vital for their recovery in a mental health setting. Mental illness in one way or another, is a breakdown in the individual’s ability to govern himself. Therefore if you take away his ability to make choices, you actually do harm to their recovery. CASBIPU believes it is fine for medical professionals to advise patients that smoking is bad for them, and provide NRTs especially including e-cigarettes upon request. But there is a world of difference between advice and a ban. Advice can cultivate one’s autonomy, and is therefore therapeutically useful, whereas a ban is the opposite.

I hope MIND can rationally discuss all these points, see sense, and ultimately issue a press release that you’ve come round to supporting CASBIPU and saying you are signing the petition. Your support would be incredibly valuable in our fight against the dawning of a new dark age in mental health care.

Yours faithfully,

Barry Curtis, Online and Social Media Co-ordinator, CASBIPU.


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Why Bombing Syria Is Not The Best Way To Defeat Islamic State

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Many countries are now involved in bombing ISIS in Syria and Iraq, with Britain expected to join the aerial bombardment in Syria soon (it’s already involved in Iraq).  ISIS clearly do deserve to die, and the barbarism in Paris on 13/11/15 has brought this need into sharp focus for many.  However this blog asks if we’re going about it the best way.

One problem is that airstrikes are imprecise – they invariably kill civilians.  So France is currently levelling whole Syrian cities based on their intelligence that they are ISIS controlled.  A second problem is that they inflame wider regional tensions which really ought to be avoided.  As the Muslim world witnesses Western and Russian airpower involved in such acts of destruction, it might lead to a greater sympathy for ISIS who would then come across as the victims.  It would be a tragic unintended consequence if the airstrikes led to an overall increase in radical Islam over the months and years to come – the point was to squish it now, not make it worse.  Thirdly airstrikes have already exacerbated the ISIS-caused refugee crisis in Europe as ordinary Syrians flee for their safety.  Fourthly they can be seen as just a PR gesture to make politicians appear effective to their domestic audiences when really they are furthering chaos.  Really the global solidarity expressed after the barbarism in Paris ought to be channeled into something more productive.  It seems then, that these problems with airstrikes would tend one to favour the sending in of ground troops.  But there are problems with this as well.

Ground troops are not the answer because they too inflame regional tensions.  When a superpower such as the US or NATO deploys troops, it still comes across as using a sledgehammer to crack a nut.  Tragically any kind of display of might by major powers appears to the Middle East as supremacist and anti-Muslim, as if they were sending a warning that “you could be next”.  Thus ground troops, while avoiding some of the problems of airstrikes, might still lead a growth rather than reduction over time of radical Islam.

It seems then we are in a quagmire.  Whilst ‘something must definitely be done’, it seems that it cannot be done by foreign states without creating worse problems.  Mercifully there is a solution – action can be taken without involving foreign states at all.

The best way to defeat the ISIS menace is for lots of individuals (possibly including members of the armed services acting in a non-official capacity) from aggrieved countries to be allowed to join Kurdish warriors who are already battling them.  The Kurds are already located in Iraq and Syria (as well as Turkey and some other countries), and they are proven to be a disciplined fighting force.  The Kurds could lead the fight against ISIS with the backing of brave and talented individuals from many other countries operating in a non-state based capacity.  It would be a people’s army, as effective as Western ground troops, but without the drawbacks.  Indeed the Muslim world, the overwhelming majority of whom hate ISIS, would cheer it.  The war could then be over very quickly without future repercussions if done in this way.

So what’s holding this realistic solution back?  Sadly some countries regard the PKK, the Kurdistan Worker’s Party who are doing most of the fighting, as a ‘terrorist army’.  Therefore anyone who wants to fight alongside them against ISIS can be jailed in certain countries, Britain among them.  On 20/11/15, a British court locked up a young woman for wanting to fight with the PKK against ISIS, elevating the letter of the law over moral decency.  Polticians’ current reluctance to remove the PKK from their list of proscribed organisations reveals their absence of a sense of solidarity with the victims of the barbarism in Paris that all of their constituents would have been rightly appalled by.

Rather than treating those who want to fight ISIS as heroes and freedom fighters, we treat them as akin to ISIS themselves, which is truly sickening.  Indeed Turkey is bombing the PKK right now in Syria (NATO is turning a blind eye).  We need to argue with the states that proscribe the PKK who, as well as Britain, France, and the USA, are Australia, Austria, Azerbaijan, Canada, Germany, Iran, Japan, Kazakhstan, Kyrgyzstan, the Netherlands, New Zealand, Spain, Syria, and Turkey, to temporarily lift their bans, just for the duration of this fight with ISIS.  Then it could be reconsidered afterwards.

This should not be regarded as a controversial demand.  The PKK has never been designated as a terrorist organisation by the UN. Most European Union member states have not individually listed the PKK as a terrorist group.  Other major powers such as Russia and China do not regard the PKK as a terrorist organisation either.  Furthermore if one looks at the history of the PKK’s relations with Turkey, it is clear that they only took up armed struggle against Turkey when she failed to grant autonomy to over 6 million Kurds living there.  So the PKK’s status in some countries’ eyes as a terrorist organisation should be a contentious issue.  At the very least, it is imperative the PKK are given leeway for the duration of the war with ISIS.  It’s our best hope of a swift victory.