do not want smoking ban in psychiatric wards
by staff reporter
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.
It is estimated that 70% of patients
in psychiatric hospital smoke, and 50% are heavy smokers. This compares
with 25% and 9%, respectively, of non psychiatric patients.
Research also suggests smoking is
higher among mental health nurses than other nurses.
The King’s Fund surveyed staff
- mainly nurses - in 420 psychiatric units on how they felt about
a smoking ban in England. A total of 150 responses were received.
Ninety per cent were against a smoking
ban in psychiatric wards.
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.
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
typically described smoking rooms as ‘dilapidated and dirty’
or ‘dark, dirty and miserable’," read the report.
the smoking rooms...had led to therapeutic benefits. The rooms were
now used for clinical activities or as lounges," the report
The King's Fund "Clearing the
air: Debating smoke free policies in psychiatric units” report
make nurses ban sectioned patients from smoking
Denise Conway, Student Mental Health Nurse & Care Support Worker,
Suffolk Mental Health Parnerships NHS Trust, St Clements Hospital.
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
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?
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?
no different to self harm. It's maladaptive - so ban it
Vandrine Brookes, senior registered mental health nurse, Royal London
Hospital, St Clements, East London Commuity Mental Health Trust
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
I am very concerned, because I did not come into a health profession
to depreciate/reduce my life expectancy. Especially as I have a
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
Louise Ford, charge nurse, Pediatric Intensive Care Unit in south
May 10, 2007
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.
me to lecture the disempowered
Jennie Dellow, Social Worker, Hertfordshire
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.
was a "management problem"
Anita Smith, thrid year student mental health nurse, University
of Teesside, Middlesbrough, Cleveland
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.
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.
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.
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.
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.
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.
as bargaining tools
Peter Wilford, staff nurse, Broadmoor Hospital
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.
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.
offer or opportunity to have a cigarette when patients become distressed
has been a very welcome bargaining tool in many situations.
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.
How to ban
Claire Kneale, health care assistant, Orchard Lodge Adolescent Unit,
February 19, 2009
We are interested in the comment made by Anita Smith. We are currently
looking at banning smoking on site for all patients but are struggling
to find out how this could be implemented especially for Sectioned
mentioned that this was problematic but didn't say how they have
overcome this if they did at all! We are keen to find out how other
units cope with inpatients that smoke on section (without leave).
And any other useful tips on how to implement a non smoking site.
Rely on nursing skills, not cigarettes
From: Stuart Archer, Clinical Nurse, PICU at Royal Hobart Hospital, Australia.
Date: May 18, 2010
I work on an 8-bedded P.I.C.U which is totally non-smoking. We offer nicotine replacemennt therapy (patches, inhalers and lozenges)as an alternative.
We have had very few incidences of actual violence in relation to this. The more psychotic patients seem less affected as they are mostly too wrapped up in their madness. By the time reality bites they are more often over the acute stages of withdrawal. Those with a borderline personality disorder like it the least but usually have the sense to appreciate that if they make too much of a fuss they might prolong their stay. Those genuinely depressed just don't care.
The reason it works here is because all staff are consistent in enforcing this ban and the patients soon see that there is no way that anyone will turn a blind eye.
The nursing staff are more easily able to de-escalate potentially aggressive situations as they have to rely on their psychiatric nursing skills on a regular basis, rather than a cigarette. We also offer many diversionary activities and pizza twice a week.
The average length of stay in our unit is 3-4 days, at which point most patients are transferred to a less acute ward which does have a smoking area. For good or bad, patients on the less acute ward who smoke are more likely to comply with ward rules and be less aggressive to avoid having to come to an area where they can't smoke.
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