July 21, 2006
by staff reporter

Almost all mental health nurses do not want smoking banned in psychiatric wards, often because they fear that it would spark aggression from patients, a survey claims.

The finding comes as the government announced a consultation on its health bill which includes a ban on smoking in psychiatric units where people are expected to stay for less than six months. Under the proposals, patients in long-stay residential units would be able to continue smoking indoors.

One respondent said: "Patients use smoking as a de-stressor. Many cannot cope without a frequent cigarette."

Another said: "A ban will lead to total rioting! It will cause mental deterioration and agitation leading to violence and aggression"

The survey found that 74 per cent of units currently provide a smoking room for patients, sometimes serving as a television or coffee lounge for smoking and non-smoking patients.

One in ten units had banned smoking inside.

A report based on the survey highlighted, however, that units which had banned smoking rejected the idea that banning would spark off patient aggression, particularly as patients could smoke outside.

Some staff also favoured a ban as it meant nurses were no longer exposed to passive smoking. A ban could also improve the ward's therapeutic environment.

"Staff typically described smoking rooms as ‘dilapidated and dirty’ or ‘dark, dirty and miserable’," read the report.

"Closing the smoking rooms...had led to therapeutic benefits. The rooms were now used for clinical activities or as lounges," the report stated.

Read for yourself:
The King's Fund "Clearing the air: Debating smoke free policies in psychiatric units” report (pdf)

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Unfair to make nurses ban sectioned patients from smoking

Comment from: Denise Conway, Student Mental Health Nurse & Care Support Worker, Suffolk Mental Health Parnerships NHS Trust, St Clements Hospital.
Date: September 7, 2006

I do a lot of bank work on a PICU ward. I believe if a person is brought on to a ward under a section it is unfair that nurses are then expected to explain that this person can not smoke on the unit seeing that they have no choice or wish to be on the ward in the first place.

Also, how will this be managed in low stimulus areas? And how are nurses expected to carry out observations on patients who wish to smoke late at night or are admitted late at night on to the ward and then wish to smoke?

I believe that to put someone under section then not allow them a room to smoke in is an infringement on their rights and that it will cause more aggressive behaviour as most people with mental health issues smoke.

Has it been taken into consideration that most outside areas are off limits after a certain time due to safety of clients and others? Will this be compromised?

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Smoking is no different to self harm. It's maladaptive - so ban it

Comment from: Vandrine Brookes, senior registered mental health nurse, Royal London Hospital, St Clements, East London Commuity Mental Health Trust
Date: November 16, 2006

Without a shadow of a doubt smoking should be banned. As health professionals our main aim is to provide and promote health and health empowerment to our client/patients. Smoking is a maladaptive behaviour - like all other antisocial or other behaviours which are deemed to threaten our health.

Our professional and natural instinct would be to provide some form of care plan to stop or minimise such maladaptive behaviours.

People psychologically/ignorantly believe that smoking is an answer to stress, reduces anxiety and agitation. Again it's a false reactive behaviour and a psychological myth. Smoking kills and can cause physical health problems. Smoking is a maladaptive behaviour. In contrast, would you encourage someone to keep cutting their wrist to release tension, pain or negative feelings. In psychiatry this behaviour is seen as a risk, and therefore a care plan is put in place to stop or reduce this risk factor. There is no difference with smoking. Operational policy should incorporate a zero tolerance policy putting in place support and help for smoking cessation. Most of these hospitals are antiquated, such as ours. A smoke room is provided, supposedly to be separate from non smoking areas. This is not sufficient, as it is poorly ventilated, small and the location is on the ward. It is simply not conducive to promoting a no smoking policy.

I am very concerned, because I did not come into a health profession to depreciate/reduce my life expectancy. Especially as I have a young family.

I served through two pregnancies in a heavily smoke environment in the 90s with no relief of a breath of fresh air.

People will talk about choice and democracy but the benefits of banning smoking outweigh smoking.

I have never smoked, and had always been healthy. During my first pregnancy I had to work in this environment. I had heart arrhythmia and was diagnosed with wolf white Parkinson syndrome.

During my second pregnancy I was diagnosed with a sarcoid swelling between the lung.

As for detained patients, provisions can be made to support and provide locations for these clients, but not at the expense of passive smokers.

..........

Ban will alienate patients

Comment from: Louise Ford, charge nurse, Pediatric Intensive Care Unit in south London
Date: May 10, 2007

Although a non-smoker who does not like being exposed to passive smoking, I feel that the government has pushed this ban without real thought as to how it will be implemented.

Furthermore, it has not even attempted to visit hospitals to discuss the ban with patients (as far as I am aware).

How will patients on wards with no leave and no access to outside space be able to smoke? Forcibly denying patients access to smoking will not make them give up, it will just serve to alienate them from the services designed to help them.

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Don't ask me to lecture the disempowered

From: Jennie Dellow, Social Worker, Hertfordshire
Date: March 5, 2008

Vandrine picture this .... you become mentally unwell and this results in you being detained under the Mental Health Act. You could be detained for a reasonably long time. The ward is now your 'home' (which is bad enough in itself) and then you are told by staff (who represent power and control to you already that you cannot smoke in your new 'home'. How do you react?

Yes of course I understand all the arguments against smoking. I did train as a general nurse and I am aware of the dangers. Please do not ask me to 'lecture' an already disempowered person about how bad smoking is for them.

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Smoking patient was a "management problem"

From: Anita Smith, thrid year student mental health nurse, University of Teesside, Middlesbrough, Cleveland
Date: April 23, 2008

I have work for the NHS for over 12 years. When the government's ban on smoking came into force I was a second year student on placement in rural area on a small acute mental health unit. This hospital is owned by the Primary Care Trust and they enforced a total ban where patients had to go off the grounds to have a cigarette.

This appeared problematic at time especially with patients with enduring mental health issues and with patients who had been placed on a section of the Mental Health Act, who had no section 17 leave due to being unwell, or at risk, and staffing issues.

Patients use smoking as coping strategy and there is medical evidence that smoking can help to reduce psychosis. However patients with mental health issues may have little insight into the dangers of smoking.

Patients on this unit became more stressed due to not been able have a cigarette for long period. On this unit there were added problems with non-smoking staff that did not wish or were not willing to take patients for a cigarette, due to the passive smoking. This appeared to cause animosity between the staff and patients, which on occasion became verbally and physical aggressive. On one occasion it lead to staff saying a patient was a 'management problem’ because of not been able to have cigarette. This person's behavoiur deteriorated and they were transferred to a PICU bed.

There was also issues of patients who wish to have a smoke late at night, due to reduced staffing and the safety of taking patients of the hospital grounds at night time, this was problematic.

I have never smoked, however I would not infringe on a person's right or choice to have a cigarette as long as they are in open space outside. I do agree that smoking should not be permitted inside of hospital buildings, however smoking should be allowed in the grounds, due to the risk of some patients and the safety of staff.

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Cigarettes as bargaining tools

From: Peter Wilford, staff nurse, Broadmoor Hospital
Date: April 23, 2008

You could well imagine the percentage of patients who smoke at Broadmoor hospital. Many are on MHA sections that run notionally and/or are running a prison sentence concurrently with their treatment plan.

So they are not expected to be released to the community for the forseeable future. Many are enduring severe mental and/or personality problems, so why take away a small privilege such as smoking.

In many cases since working within many and varied mental health units and community teams I have witnessed scenarios that have diffused possible and impending violent and physical aggression.

The offer or opportunity to have a cigarette when patients become distressed has been a very welcome bargaining tool in many situations.

However, I do not discount the long term ill-health that poses from smoking. Health promotion and the offer of smoke cessation should always be available to all patients.

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