Smoking bans threaten mental health: Opinion, Australia

This writer asks why comprehensive smoking bans are imposed on mentally ill people, when at least at this point in our history nobody would think it right to impose such a comprehensive ban on the rest of the community. Both the circumstances of a person's incarceration in mental health facilities and the fact that they may not get home for a period of days, weeks or months, to say nothing of their existing mental anguish and the effects of any medication, make somebody's stay in a mental health facility possibly one of the least suitable times to deprive them suddenly of nicotine and expect them to get by on patches at best.


There do seem to be people out there in the caring profession who find the opposite and who knows but they may be most sincere in their views. But bringing in a comprehensive ban that will force psychologically disturbed people to withdraw suddenly from nicotine would be controversial even if implemented in a single unit. The current trend is for health departments to encourage if not legislate for the provision of comprehensive smoke-free mental health service, affecting all units everywhere.  People who run these departments are not medics, they are officials, who seem to be motivated by targets and ideologies dressed up as care for patients.


The comments on this story are instructive too, especially the one that points out that 'nicotine replacement is not an alternative to smoking, it's an aid to give up smoking'. In the eyes of tobacco control, nicotine replacement is a form of 'harm reduction': i.e. anything is better than smoking (as long as it's not made in China with cartridges of course) and we'll give you nicotine patches because you really want to give up smoking, don't you – most smokers do, after all! One reader says:

We should not be allowing or encouraging people to utilise pathological coping mechanism when they are facing a crisis. When alcoholics and heroin addicts are admitted we provide healthier alternative and encourage them to reduce their dependence. 

But this is a false parallel. No one is admitted to psychiatric care because he or she is a smoker. Drug and alcohol abuse signify addictions of a completely different order from a nicotine habit. There is no reason that any patient should be compelled to give up smoking. Allowing smoking areas need not undermine the ward experience for everyone else. It's just a matter of will.


To finish let's have another story about Champix (comments disabled). Sorry it's from the Daily Mail. The MHRA (medicines regulators) are convinced that people who react to Champix have underlying problems (even though most reports I have read concerned people without any history of psychological problems I can't pretend to have read enough to be certain of this). This will account for ASH Scotland's keenness to recommend Champix to those in mental health facilities.