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.
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.
Policy and Campaigns Assistant
(Mental Health Services)
15-19 Broadway, Stratford, London E15 4BQ
Registered charity number 219830. Registered in England number 424348.
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.
Barry Curtis, Online and Social Media Co-ordinator, CASBIPU.