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

Cigar_smoking_woman_in_Cuba

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

  1. I am not a smoker but I am against the smoking ban in psychiatric hospitals.

    It should be possible to have non-smoking areas in the ward and outside.

    To enforce smoking bans is an appaling thing to do that will raise stress for a lot of people.

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  2. Barry, good on you. A few points that may be of use to you.

    Antismoking isn’t new. It has a long, sordid, at times very violent, 400+ year history. It is typically associated with totalitarian frameworks. There were antismoking crusades long before the large tobacco companies came on the scene. There were antismoking crusades long before the mass-produced cigarette. There were antismoking crusades long before movies and mass media. There were antismoking crusades long before attempts, however bastardized, at scientific investigation of smoking. There were antismoking crusades long before the recent concoction of secondhand smoke “danger” [The term “passive smoking”, without basis, was coined during the N#zi era].

    The common theme over those 400+ years is the extent to which rabid antismokers will lie to rationalize their incoherent hatred of smoke/smokers/smoking. Hostility, violence, cruelty, bigotry, neuroses, megalomania, pathological lying, a “god complex” – antismoking has it all. There’s more than ample evidence over the last few centuries that the rabid antismoking mentality (misocapny) is a significant mental disorder. Yet here we are again.

    http://www.americanheritage.com/content/thank-you-not-smoking
    See also:
    “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.

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  3. A few points on smoker “earlier” mortality. You’re correct. These are averages. For smokers, average life expectancy is ~72. For nonsmokers, ~82. A year in one’s 60s, 70s, 80s is not like a year in one’s 20s or 30s. Beyond one’s 50s, the years get progressively tougher. Age 72 is not young, nor is it “early” or “earlier” mortality. Rather, it is “not as late” mortality.

    Further, there is a plethora of other risk factors (confounders) for “not as late” mortality that are never accounted for in these antismoking diatribes that fraudulently assign “not as late” mortality solely, singularly to smoking.

    Who decided that everyone must play this deranged statistical game in an attempt to meet mortality averages? Who decided that everyone should be forced to play a vacuous statistical game in the hope of living into very old age and protracted disability? The questionable adage “only the good die young” has been inverted into the as questionable “only the good die very, very old”. While Public Health uses longevity, as if important unto itself, for the purposes of eliminating smoking, Public Health also views longevity as “problematic”, particularly as the baby boomers come through old age. Old age isn’t a bed of roses. It can be very grueling and requiring considerable medical care that will put a monumental strain on resources as the large “boomer” group comes through.
    http://express.co.uk/posts/view/230685/Ageing-population-is-threat-to-economy-

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  4. The simple-minded Public Health framework is just stark statistics devoid of the art and detail of living. If people wanted to live an ascetic lifestyle, they would do better joining a monastery. Antismokers are prohibitionists that care for nothing other than their deranged goal. Most will encounter at least some misery in advanced years unto mortality. But when prohibitionists are let loose, they will make the many living years long before we get to the dying part a misery too.

    The current antismoking crusade was begun in the 1960s by typical prohibitionists (see Godber Blueprint http://www.rampant-antismoking.com ). It’s a continuation of [physical] “clean living” hysteria that goes back to 1800s America and was also seen in the N#zi era.

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    • The incessant moralizing of the prohibitionists even attracted the ire of pipe and cigar smoker, Mark Twain, penning “The Moral Statistician” in the latter 1800s.

      “The Moral Statistician”
      Originally published in Sketches, Old and New, 1893

      “I don’t want any of your statistics; I took your whole batch and lit my pipe with it.
      I hate your kind of people. You are always ciphering out how much a man’s health is injured, and how much his intellect is impaired, and how many pitiful dollars and cents he wastes in the course of ninety-two years’ indulgence in the fatal practice of smoking; and in the equally fatal practice of drinking coffee; and in playing billiards occasionally; and in taking a glass of wine at dinner, etc. etc. And you are always figuring out how many women have been burned to death because of the dangerous fashion of wearing expansive hoops, etc. etc. You never see more than one side of the question.

      You are blind to the fact that most old men in America smoke and drink coffee, although, according to your theory, they ought to have died young; and that hearty old Englishmen drink wine and survive it, and portly old Dutchmen both drink and smoke freely, and yet grow older and fatter all the time. And you never try to find out how much solid comfort, relaxation, and enjoyment a man derives from smoking in the course of a lifetime (which is worth ten times the money he would save by letting it alone), nor the appalling aggregate of happiness lost in a lifetime by your kind of people from not smoking. Of course you can save money by denying yourself all those little vicious enjoyments for fifty years; but then what can you do with it? What use can you put it to? Money can’t save your infinitesimal soul. All the use that money can be put to is to purchase comfort and enjoyment in this life; therefore, as you are an enemy to comfort and enjoyment where is the use of accumulating cash?

      It won’t do for you to say that you can use it to better purpose in furnishing a good table, and in charities, and in supporting tract societies, because you know yourself that you people who have no petty vices are never known to give away a cent, and that you stint yourselves so in the matter of food that you are always feeble and hungry. And you never dare to laugh in the daytime for fear some poor wretch, seeing you in a good humor, will try to borrow a dollar of you; and in church you are always down on your knees, with your ears buried in the cushion, when the contribution-box comes around; and you never give the revenue officers a full statement of your income.

      Now you know all these things yourself, don’t you? Very well, then, what is the use of your stringing out your miserable lives to a lean and withered old age? What is the use of your saving money that is so utterly worthless to you? In a word, why don’t you go off somewhere and die, and not be always trying to seduce people into becoming as ornery and unlovable as you are yourselves, by your villainous “moral statistics”?

      Now, I don’t approve of dissipation, and I don’t indulge in it either; but I haven’t a particle of confidence in a man who has no redeeming petty vices. And so I don’t want to hear from you any more.”
      http://stkarnick.com/culture/?p=23674

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  5. While it despises all else about the West, the bloodthirsty murderers of ISIS have adopted the West’s antismoking, something more with which to bludgeon their captives, 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 to conformity. 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.

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