A recent post on this blog shows that, far from being demanded by respondents to the 2009 Scottish Government consultation on smoke-free services, both the guidelines themselves and the achievement of a smoke-free mental health service have been opposed by most of the patients' groups that responded.
Andy Kerr, Scottish Minister for Health at the time the smoking ban legislation was passed in 2005, said the following in committee:
The approach was largely humanitarian and involved common sense, in my view. Residential homes are where people live and have their home. We felt that, as long as there was a smoking policy in such places, people would have the right to smoke where it was deemed to be their home, just as others in the community have that right. That applies to adult care homes, but not to children's homes.
Adult hospices are on the list of exempt premises for obvious humanitarian reasons. Psychiatric hospitals and units are included on the list because clinicians and others told us that that would be appropriate, if individuals' overall mental health and well-being were to be looked after. There were obvious humanitarian and other reasons for that exemption [...]As we have asked before, what has changed?
Has anything actually changed? The small print, as far back as December 2005 (pp. 13–14 in a document signed by the same Health Minister, Andy Kerr), said:
However, the Scottish Executive recognises that the physical health profile of those with mental illness in Scotland is poor and smoking rates are traditionally high. It is committed to reducing the health inequalities experienced by this group of patients and will work with service providers to implement a programme of targeted cessation, which may allow the exemption for designated rooms to be reviewed in due course.Ever since announcing the exemptions, the Scottish Government has been working to get rid of them:
And here is the resulting government press release:
"This is a further step towards our vision of a smoke-free Scotland. Patients and staff in mental health services should have the same opportunities to enjoy the benefits of a smoke-free environment as the rest of the NHS in Scotland.
"Allowing smoking in residential mental health services, when it is completely banned in all other NHS settings, simply perpetuates inequalities.
"Removing smoking rooms in mental health settings will undoubtedly be challenging but there is evidence that smoke-free policies can be effectively introduced and this guidance will help health boards to achieve that.We're still waiting for a comment from Andy Kerr (and have been since December 2010).