Although the issue of psychiatric total smoking bans (i.e. even outdoors) is under-reported and under-discussed in society (they may be fully implemented by 2018), there is near unanimity amongst those who have heard of them that they are cruel. The only champions are various ‘public health’ organisations, and they have realised they need stronger arguments to get an easy ride. Sadly, for them, science is not on their side, so they have concocted some of their own “facts”, apparently backed up by “scientific studies” they hope the layman won’t look at (because they actually refute public health’s claims!)
Thus, ASH (Action on Smoking and Health) have now released a 48-page document of turgid reasoning that makes some fantastic claims regarding mental health and smoking. As with claims of this nature, the solutions put forward would be laughable in a free, democratic society were it not for the sad truth Government is taking it seriously.
So for example, ASH inform us that “Mental health conditions affect almost a quarter of the population who die on average 10-20 years earlier than the general population. Smoking is the single largest cause of this gap in life expectancy.” (p.7) This is astonishing stuff. ASH are claiming almost 25% of the population are mad, and that they die earlier from smoking related diseases. Is this true? Thankfully not.
In 2013, there were 506,790 deaths registered in England and Wales. If ASH is right, 25% of these should be mad people who were also smokers – just over 126,000. And add to that all the smokers who died who weren’t mentally ill – ASH says two thirds of them – and our total smoking related death figure should be 378,000.
But the estimated figure for total smoking related deaths is actually only 79,100 per annum (Source: Office of National Statistics). According to ASH, a third of these smokers would have been mentally ill at some point – the figure is therefore 26,366. Obviously this is still regrettable, yet out of a total population in England and Wales of just over 56 million, it isn’t actually alarming.
We also need to interrogate whether the mentally ill really do die 10-20 years younger on average, and what this means. This statistic was established by researchers at Oxford University in 2013, but their lead researcher actually did not pin the blame entirely on smoking.
Dr Seena Fazel, of the Department of Psychiatry at Oxford University, accounted for the higher mortality rate thus:
“High-risk behaviours are common in psychiatric patients, especially drug and alcohol abuse, and they are more likely to die by suicide. The stigma surrounding mental health may mean people aren’t treated as well for physical illness when they do see a doctor. Many causes of mental health problems also have physical consequences and mental illness worsen the prognosis of a range of physical illnesses, especially heart disease, diabetes and cancer. Unfortunately, people with serious mental illnesses may not access healthcare effectively.”
No mention of smoking in this quotation. Indeed, the broad scientific evidence seems to show that the average decrease in life expectancy for anyone (i.e. regardless of their mental state) from smoking is actually only 7 years. (See Snowdon, C. “Velvet Glove, Iron Fist: A History of Anti-Smoking”). If the mentally ill were dying 10-20 years younger then, it wouldn’t be smoking related diseases that got them because they are dying before these strike.
As Fazel says, suicide is a problem. If someone commits suicide in their 20s, it throws the whole “mean average” into a distortion. You could have 9 people living to 80, but if 1 dies at 20, the “mean average” becomes 74. Yet to say the average is 74 is to gloss over the fact 90% made it to 80. If this is multiplied across the 25% of the population ASH believe are mentally ill, you get some ridiculous figures that hide the very real complexity. Damn statistics!
ASH of course deny this. Their report fantastically claims that smoking related deaths lower the mean average more than suicide does. Yet the two studies they quote to support this counter-intuitive thesis do not back it up. A study of Americans says “Persons with mental disorders died an average of 8.2 years younger than the rest of the population” – that’s 8.2, not “up to 20”. Furthermore, it says when you add up all the variables such as lower socio-economic status, demographic factors, and clinical factors, then “the association was reduced by 82% from baseline and became statistically nonsignificant”. Meanwhile the other source which was a study in Western Australia says, “the life expectancy gap increased from 13.5 to 15.9 years for males and from 10.4 to 12.0 years for females between 1985 and 2005” – not quite the 20 years’ figure touted by ASH. Furthermore, it definitely does not say this is all down to smoking. What it does say is that deaths from cancer accounted for 13.5% – but it also says deaths from suicide were 13.9%, i.e. higher, although cardiovascular disease accounted for 29.9%. And if we bear in mind that not all cancers and heart disease are down to smoking, we can reject ASH’s claims outright.
The ASH report goes further than the previous PHE (Public Health England) report in recommending patients are monitored even after discharge from a smokefree lunatic asylum. They want doctors, social workers, and others to keep up the message to out-patients that smoking is really bad. Worse still, in “Ambition 11”, they say they want to identify anyone in society who is “at-risk” of becoming mentally ill to receive these same messages from various professionals. Who are these people ASH knows are at-risk? They say, “”certain groups in society may be particularly susceptible to experiencing mental health problems, including households living in poverty, people with chronic health conditions, minority groups and those who experience family conflict or neglect.” So basically ASH want to colonise Job Centres, Wetherspoons, and the family home whenever a disturbance is reported, or if you receive visits from social workers. And these might be people who have never smoked or never will – they’re all ripe for intrusion in ASH’s eyes, such is their zeal. That this will become an unhinged tyranny should now be obvious.
Of course, ASH would deny they are authoritarian, they would simply say ‘they care’. In Princess Di-sounding language, the report is entitled “The Stolen Years” (without ever saying who the thief is and what they do with the ‘property’ of someone else’s years, if the analogy can possibly make sense).
ASH Trustee Paul Burstow, himself a former MP who was kicked out by the people in the 2015 General Election says, “Seventy percent of those discharged from a psychiatric hospital are smokers. The result is lives cut short and in their final years lives blighted by heart and lung diseases, stroke and cancer. These are the stolen years – of life, of health and of wealth…This is not a quick fix, nor will it be easy, but without a collective effort we will continue to condemn millions of the most vulnerable people in our society to needless death and disease.” (p.5)
Thus for Burstow, leaving people to make their own choices is “condemning them to death”. Burstow, who is of course Immortal and Infallible, needs to urgently realise that if life is to mean anything, we have to be able to be autonomous, at least to a degree. To choose to smoke a cigarette is one small choice that is often a rational choice, and if we’re not even allowed that, then freedom has been condemned to a needless death.
The cruel irony is that it is only in conditions where freedom can flourish that people gain the maturity and resilience to be able to quit smoking. Therefore, ASH’s proposals won’t necessarily work even in terms of lowering smoking rates, they’ll just create misery. Now, in 2016, with e-cigarette technology being excellent, there are potentially more opportunities for people to decide to quit – but if this becomes compulsory they cannot reap any reward whatsoever from what the Government advertising label’s claim “choose freedom”. The question it would instead arouse is “why bother?”
Watch this YouTube video explaining what is wrong with mental health smoking bans – produced by The Campaign Against Smoking Bans In Psychiatric Units (CASBIPU)