ASH Want To Turn The World Into A Giant Smokefree Lunatic Asylum

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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).

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ASH Trustee Paul Burstow, from the mis-named Liberal Democrats

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?”

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Watch this YouTube video explaining what is wrong with mental health smoking bans – produced by The Campaign Against Smoking Bans In Psychiatric Units (CASBIPU)

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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.


Outdoor Smoking Bans Debated At The Battle Of Ideas

How Dare You! An African-American woman lighting up in a park - soon to be banned. (c) Bill Branson/WikiCommons
How Dare You! An African-American woman lighting up in a park – soon to be banned. (c) Bill Branson/WikiCommons

This is the text of my introductory remarks for a session called ‘Hot Off The Press: Outdoor Smoking Bans’ at the Battle of Ideas conference, October 18th 2015.  Other panellists were Josie Appleton and Dolan Cummings from civil liberties campaigning group The Manifesto Club, and Simon Clark, Director, smoker’s rights group FOREST.  Chair: Rob Lyons, Action on Consumer Choice.  My remit was to talk about outdoor bans as they afflict sufferers of mental illness within psychiatric wards where outdoor bans are gaining pace.

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I don’t think anyone should be forced to give up smoking against their will. I know we are in the middle of ‘Stoptober’, but come on – giving up when you’re in the middle of a mental breakdown is inhuman. I can’t think of a worse time or place to quit.

That’s the way I see it, but public health quangos instead say it’s a prime time to intervene because they have a powerless captive audience.

They really believe they have a duty to treat one’s smoking as if it was a part of your condition, so are demanding a total outdoor ban.

This goal of health is a joke – since the indoor ban came in, cases of self-harm are up 56%.  In America, since outdoor bans came in, violence is up 22% and average duration of detention has increased by nearly 90%.  This is interpreted by authorities that we are in a ‘mental health epidemic!’, oblivious to the more likely truth that smoking bans are causing bad behaviour.

Furthermore most patients go back to smoking within 5 days of discharge anyway.  Some result.

Public Health England think the high rate of smoking amongst the mentally ill is a ‘health inequality’ that must be tackled.  The main problem with this is that the old principle of autonomy never gets a look in.

Because they have overlooked autonomy, smoking bans are cruel at a time when the individual is at their most distressed. Smoking is often their only comfort. Also bans inevitably deter smokers from seeking help if they are developing mental illness because the idea of spending time in a clinic is unbearable. Star Trek Voyager's Seven of Nine: Out of Range

Back in 2001 when I was Sectioned after trying to contact Star Trek Voyager’s Seven of Nine, not the actress, the actual character, the care was pretty good back then. You could smoke both in a dedicated room and outdoors. Barriers between patients and staff were also broken down thanks to a shared smoke and their getting your tobacco.

Smoking bans destroy that trust – a nurse confiscating your tobacco upon entrance would appear like a prison guard rather than someone on your side.

The next step will be to replace vending machines that currently sell Coca-Cola and chocolate with one’s that sell only carrot juice and Omega 3 supplements – after all, patients also have a tendency to become obese.

If you were a smoker in hospital for a broken leg, a ban wouldn’t stop your healing. But if we understand mental illness as a breakdown in reason and autonomous functioning, then smoking bans do prevent full recovery by cementing the patient’s lack of self-control.

One of the first clinics to ban smoking was Islington. They said “We are filling the void with activities like dance”.

It seems to me they don’t want patients to regain their humanity but sing like children: “If you’re happy and you know it clap your hands”.

Public health types argue patients will be grateful for the smoking ban, coming out as ‘changed beings’. But really this is like Winston Smith in Orwell’s 1984 after having endured Room 101, he declares “I love Big Brother”.

If we add this all up, then metaphorically speaking, think of the treatment endured by Jack Nicholson’s character in One Flew Over The Cuckoo’s Nest. In that film, after massive electricity is applied to his brain, he emerges as a grinning blob who has been lobotomised. We should wonder why today’s public health managers want to replicate that.

 

‘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.