H/T Dick Puddlecote for this article in SANE: The Madness of Banning Smoking in Psychiatric Units:
In my opinion, and as a former patient with schizophrenia, new public health policy may be in breach of the Hippocratic Oath that used to compel medical professionals to “first, do no harm”.
Since I drew attention to one NHS Trust’s decision to ban outdoor smoking in psychiatric units, my worst fears are unfolding. Several others have now followed East Lancashire’s lead: Oxford, Mersey, South London and Maudsley, with more to follow as ‘Public Health England’ (PHE) and the ‘National Institute For Health and Care Excellence’ (NICE) demanding a total outdoor ban across the country.
Forcing patients to quit smoking when they’re in the middle of a mental breakdown is intolerably cruel. There is no worse time or place that mental patients would cite as a desirable opportunity to quit.
Further on, he lists the dire consequences:
The invasion of public health policy into what was almost becoming a humane system of psychiatric care has created massive problems on the ward. Due to the role played by PAHs, total smoking cessation can be very dangerous when mixed with starting or increasing a course of anti-psychotics. The journal Current Psychiatry notes that symptoms that accompany this unholy alliance include extreme fatigue, myoclonus, orthostatic hypotension, seizure, sialorrhea, somnolence, tachycardia, and worsening psychiatric symptoms. Smoking cessation may therefore be in breach of the Hippocratic Oath for medical professionals that held ‘first, do no harm’.
In addition, since the indoor smoking ban came in, cases of self-harm have rocketed by 56% in the UK. Meanwhile in the USA, where state-run units in 35 of the 50 states now have some form of outdoor ban, patient-on-patient violence has risen by an average of 22% and up to a whopping 390% in Austin, Texas. Furthermore average durations of stay have increased by nearly 90%.
He reflects on the experience of smoking:
Sadly public health types only regard smoking as a form of nicotine dependency. They honestly believe the effect of their daft bans can be mitigated with nicotine replacement therapies and, amongst the really radical (not many), with e-cigarettes. But tobacco is much more than a nicotine-hit. It’s not just that smoking is far more pleasurable than nicotine substitutes, nor that it helps alleviate the side effects of medication, and indeed certain psychotic symptoms such as attention deficit, learning, anxiety and depression. Tobacco also has a long history of being associated with freedom, and this is what the mentally ill chiefly yearn for. Whether or not smoking really is a good way to express freedom is technically irrelevant – the important point is that it has this cultural symbolism and feel. E-cigarettes, as a new innovation, lack this history. There are no films, TV programmes, nor music I can think of that depict vaping as cool.
The natural companion to the sense of freedom is friendship with other people. Thus sharing a smoke with other patients and staff used to be part of one’s social activity. It had the massive benefit of breaking down barriers by being a shared experience. As such, it genuinely did aid recovery. It is therefore no surprise to those of us familiar with human nature that self-harm and patient-on-patient violence has risen since the bans: take away the cigarettes, and you inevitably turn people against each other. Tell them this is only a consequence of their diseased brain, and they increasingly hate themselves. This then appears to psychiatrists as a worsening mental health condition, hence the increase in duration of stay.
I have no first-hand experience of psychiatric units. All I do know is that in those times in my life when I’ve been psychologically stressed, cigarettes have always been a great help. And so it seems to me to indeed be intolerably cruel to deprive people of this crutch at the very moment in their lives when they need it most. And it also seems psychologically counter-productive to do such a thing. It is, in physical terms, like admitting someone into hospital, and immediately taking away their walking stick, and breaking both their legs.
But I’ve long ceased to believe that there is any ‘psychological’ dimension to Tobacco Control’s notion of health. They are always and invariably entirely devoid of all empathy or compassion. As best I can make out, they simply measure ‘health’ inversely with tobacco consumption: so that H = k / N, where H is health, and N is cigarettes smoked/day, and k is some constant. When N = 0, H = infinity, and you live forever. They know this because they already know that tobacco is the cause of all cancer, of all heart or lung disease, and in fact of all disease. And since they believe that all physical disorders are caused by smoking, they probably also believe that all psychological disorders are also caused by smoking.
That there are deleterious psychological effects from smoking bans in psychiatric units must be obvious to anyone with the slightest trace of empathy for their fellows. But that raises the wider question of whether there are deleterious psychological effects from smoking bans in the wider community outside psychiatric units. Smoking bans are also extremely cruel to ordinary smokers, never mind psychiatric patients. It’s a question that could have been asked in the ISIS survey, but was not. It might have been something like: “Do you suffer more from depression/anger/anxiety/loneliness after the smoking ban? [always][sometimes][never].” I for one have always been angry to some degree or other since the introduction of the UK smoking ban. In fact I was getting so angry at times that I worried that I might have an apoplectic fit. Cigarette consumption rocketed for a while.
But I doubt if any of these considerations will make one jot of difference. Tobacco Control seems to be in top down control everywhere, and if they want smoking banned in psychiatric units, it will be banned.
I just hope that, when the resulting disaster is finally clear to everyone (as one day it will be), Tobacco Control will be destroyed, and its practitioners treated with the exact same lack of compassion that they themselves demonstrated.