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Sunday, 20 February 2011

Scottish Government guidelines for smoke-free mental health services

Here at last are the guidelines directed to health trusts, designed to show them how to implement a completely non-smoking regime in institutions and facilities dedicated to psychiatric care.

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:


It is clear from this that the Scottish Government's wish is for mental health services to go smoke-free. We now know that the consultation responses did not show public support for comprehensively smoke-free mental health services. Not that a rejection rate of around four-fifths of patient group participants is anything for the government to worry about.

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).

6 comments:

Anonymous said...

The Analysis of the consultation responses can be viewed at this link:-

http://www.scotland.gov.uk/Resource/Doc/924/0096158.pdf

Of particular interest is the response to the Question "HOW DO YOU THINK WE SHOULD PROCEED?"

Table4.1 on Page 11 gives the results and the following summary:-

Just over one-third (35%) of those who responded to this question recommended that the existing exemption which permits smoking in designated rooms be removed by amending the existing legislation.

Around one in ten (12%) of
respondents advocated producing detailed guidance material without amending the legislation.

Within different respondent categories, the balance of views varied (Table 4.2
overleaf).

Overall, individual respondents were more in favour of retaining the status quo (55%) than organisational bodies (41%).

The vast majority (81%) of
patient representative groups advocated the retention of the status quo, as did 6 out of 10 of respondents who identified themselves as current service users.

NHS bodies were least likely to favour this option, with less than one quarter (23%) of these respondents recommending the status quo.

NHS bodies were those most likely (63%) to recommend amending current
legislation to remove the exemption permitting smoking in designated rooms in psychiatric hospitals and psychiatric units. In contrast, only 12% of patient groups and 28% of individual current service users favoured this option.

Anonymous said...

The Health zealots will not listen to the voice of reason. They understand only one language - the language of the gun barrel.

Michael J. McFadden said...

So, 63% of "NHS bodies" want to "remove the exemption permitting smoking in designated rooms in psychiatric hospitals and psychiatric units" eh?

Well, I'd like to help them out with the following suggestion: they simply need to stand behind their principles and guarantee to cover any medical/psychiatric damages resulting from such things as depression or failure to check into NHS facilities due to the ban. Physician/Psy-care-givers could be the source of attestation for the contribution of the ban to such things.

Additionally, they could guarantee to cover both the physical costs and the lawsuits from any patients or their families that resulted from fires caused by incidences of "hidden smoking" with resultant improper and hasty disposals of materials without ashtrays or in private, out-of-the-way locations.

Of course it wouldn't be right to take those monies from other patients, but I'm sure the "NHS bodies" themselves and their members would be happy to cover such costs from their own salaries and estates. After all, they claim such costs don't exist or will be insignificant right? They can't lose, and it would help them get the smoking ban they desire!

Think they'll accept the challenge?

Or will they run like a little girl from a pack of tarantulas?

Michael J. McFadden,
Author of "Dissecting Antismokers' Brains"

health quotes. said...

I'd like to help them out with the following suggestion: they simply need to stand behind their principles and guarantee to cover any medical/psychiatric damages resulting from such things as depression or failure to check into NHS facilities due to the ban.Just over one-third (35%) of those who responded to this question recommended that the existing exemption which permits smoking in designated rooms be removed by amending the existing legislation.

Anonymous said...

The Scottish Government add insult to injury with this announcement:-

"Guidance to give residential mental health patients and workers the same protection from second-hand smoke as others throughout Scotland was published today.

Smoking has been banned in public places since 2006. However, residential mental health facilities are exempt from the ban and smoking is allowed in designated rooms.

Today's guidance is designed to help residential mental health facilities to become smoke-free although there are no plans to introduce a statutory ban.

Public Health Minister Shona Robison said:

"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 committed to reducing smoking rates in Scotland and the misery caused by tobacco related illness and this guidance will help to make mental health facilities healthier places for people to live and work in."

The guidance has been developed following a consultation - Achieving smoke-free mental health services in Scotland - which was carried out in 2009."

http://www.egovmonitor.com/node/40827?

Belinda said...

That's already quoted in the post above, anon – the final link.