Royal Edinburgh Hospital now a no-go area for smokers

In fulfilment of the ambitions of smoking ban advocates everywhere, the Royal Edinburgh Hospital (Edinburgh's psychiatric hospital) banned smoking everywhere on the site at the beginning of 2011, with the exception of two smoking shelters. This involved closing the smoking rooms that marked psychiatric hospitals as exempt premises when the smoking ban was introduced.

The outrage expressed in the article can be understood against the Scottish Government's determination to challenge the exempt status of psychiatric units in respect of the ban, in spite of all the consultation results (read here, and here). Eighty-one per cent of patient groups voted against the ban, and only one-third of respondents voted in favour of the exemption accorded to psychiatric units being removed. This must be weighed against the conviction of health board directors that smoking doesn't relieve stress for patients in psychiatric hospitals.

Apart from the danger of people lighting up covertly, and the inconvenience to staff of having such limited smoking facilities on the hospital premises, there is also the issue (reflected in this report) of a blanket smoking ban resulting in more involuntary admissions and/or people avoiding psychiatric treatment.

Freedom to Choose (Scotland)'s effort to challenge the Scottish Government on this issue was brushed firmly under the carpet. Throughout, the government's intention has been to avoid parliamentary scrutiny of the results of its consultation on smoke-free mental health services and its findings.

More involuntary psychiatric admissions since smoking banned, says Canadian study

A study in Toronto that appears to be the first of its kind suggests that the smoking ban deters many patients from seeking treatment in psychiatric units. A walk-in emergency unit found it had to detain patients who needed treatment but were unwilling to submit to a no-smoking regime; other patients refused treatment but did not meet the required criteria for involuntary admission.

Involuntary treatment involves the removal of their freedom for an indefinite period. Having to give up smoking during such a period adds complications to an already upsetting if not downright traumatic experience. Many times I have wondered at the conscience of people who pick on those detained, quite probably bewildered and confused souls as targets for their conviction that the way to save humanity from itself is to stop everyone smoking. This is touched on in the article: 'what I haven't seen is the investment in resources to help these individuals when they are stable outpatients'. No: sock it to them when they are vulnerable and have no choices. Many clinical staff and academics have reservations about this.

It is clear that many of those at most risk are those outside hospital, who become aware that admission to hospital will involve them giving up smoking. (See Letters to the Department of Health.) The news that walk-in appointments are found to result in more involuntary admissions is very bad news, if it means that people are deterred even from seeking an assessment or help in an emergency.

It appears that not much work has yet been done to investigate whether people are being deterred from treatment on the grounds that they won't be able to smoke while hospitalised.