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Robbed of the right to smoke

The ban on smoking in enclosed public places has caused controversy, but what if you couldn't smoke in the place where you lived? It's what mental health patients are claiming.

Life in a typical mental health unit is not exactly festooned with luxuries. Like all hospitals, they can seem cold, clinical and austere places to many patients.

And life is about to get worse for many of those held in a unit. By 1 July 2008 they must all be smoke-free. Prisons, on the other hand, will remain exempt from the smoking ban.

The move is likely to anger many patients, who are not allowed to leave the unit and are not being punished for any crime. Already three are taking legal action over their right to smoke.


You have the choice to smoke in prison, but not in a mental hospital - but prisons are there for punishment, and hospitals are there for treatment
Rob Beech, legal advocate

Two of the cases, brought by Terrence Grimwood and another patient, are arguing against the early introduction of the ban at Rampton secure hospital by Nottinghamshire Healthcare NHS Trust in March 2007.

They say the ban infringes their human rights, namely article 8 of the European Convention on Human Rights, which guarantees respect for private and family life.

The third case, brought by a Rampton patient who can only be identified by their initials of WN, is against the secretary of state for health, for bringing the legislation through Parliament.

The patients argue the hospital is effectively their home and therefore they should be able to smoke. The new rules even prevent them smoking in the grounds.

Hospital is home

Smokers make up 26% of the general population, but 70% of mental health inpatients are smokers, according to Mental Health Today.

Mr Grimwood's solicitor, Marcus Brown, says it is a question of basic freedoms.

"They are being deprived of the choice of doing what they want," he says.

Legal advocate Rob Beech is representing the third Rampton patient to bring a legal challenge against the smoke-free policy.

"You have the choice to smoke in prison, but not in a mental hospital," he says. "But prisons are there for punishment, and hospitals are there for treatment."

One person who thinks the effects of the ban could be catastrophic is former patient, Judy Mead.

The 42-year-old, from Bristol, was sectioned twice - in 1985 as a 19-year-old and then again two years later. She spent several months as an inpatient and smoked about 15 cigarettes a day.

"I hadn't committed any crime when I was in a mental health unit and I was already angry at why I'd been sectioned, so being prevented from smoking would have made things worse.

Coping method

"What would have happened is that I would have been given more medication, because I already felt suicidal and having to give up smoking so suddenly would have made me more determined about taking my own life.

"For the first few weeks, my parents dissuaded my friends from visiting and as I didn't know any of the patients, the only friend I had was a cigarette."

A spokeswoman for Nottinghamshire Healthcare NHS Trust said the ban had been introduced across the whole of the organisation in March, and not just at Rampton.

Patients are all offered help with stopping smoking, she says.


MENTAL HEALTH AND SMOKING
40% of mental health service users smoke
70% of mental health inpatients smoke
50% of those using inpatient units classed as heavy smokers
Between 70% and 74% of people with schizophrenia smoke
56% of people with depression smoke

Emily Wooster, of mental health charity Mind, argues that asking people to stop smoking while they were mentally unstable could prove problematic for them.

"People who use mental health services are twice as likely to smoke as those who do not, and some may use this as a means of coping with distress," she says.

And there is even an argument that suddenly being made to give up smoking could worsen their problems, suggests Dr Chris Allen, a consultant clinical psychologist.

"If they're using smoking as a way of assistance to cope with their mental health problems, and then that's taken away, that could lead to problems being exacerbated."

A Department of Health spokesman insisted it was a question of mental health patients being entitled to a smoke-free environment, like other NHS users.

But whatever the arguments of those who want the smoking ban, many mental health patients will continue to think they are being singled out unfairly.

Below is a selection of your comments.

As a non-smoking community mental health nurse I have to agree with the in-patients comments. It is definitely not the best time to give up smoking when their mental state is unstable, and will-power is weaker than when mentally well. Ethically it's wrong to force vulnerable people, who may have no choice about being in hospital, to give up even though we know the health benefits of them doing so. The answer is to provide well ventilated separate smoking areas and probably a specialist support service to assist those individuals who choose to do something about their addiction.
David Barclay, Kirkcaldy, Scotland

This is typical of the way we are being forced to live by this government - the guilty are rewarded and the innocent are hounded for doing something perfectly legal. How arrogant of the Nottingham NHS spokesperson to blithely defend this blatant disregard of people's rights by saying they will be offered help to quit - what if they do not want to? Smoking is, as far as I am aware, still legal in this country and therefore every citizen should be given the right to exercise the freedom we are supposed to have - with the exception of people in prison, who are being punished for breaking an actual law and not just a knee-jerk health-freak one. It seems that the "human rights" of prisoners are far more important than those of the general population - the answer? Light up in a public place, get sent to prison and then puff away to your heart's content, safe in the knowledge that the government is too busy restricting the basic freedoms of the general population to realise that! You are doing as you please in the very situation which should restrict your freedom.
Paula, Ipswich, Suffolk

Whilst it would seem reasonable to create healthier environments for all, I believe that patients in mental hospitals are already under many pressures. My mother spent time on several occasions in mental hospitals and smoking was one of the ways which helped her to cope. I believe that by forcing patients to not smoke, could exacerbate their problems. It would be better to provide a separate smoking area and gradually help the smokers to weane off the cigarettes along with the other help being given for treatment.
Christopher Merriein, Chichester

It's ludicrously unjust to deny detained psychiatric inpatients the right to smoke while allowing prison inmates to do so.
Gavin Nash, Manchester, UK

Some mental health inpatients already feel, because of the state of their mind, that they are already being punished because, for various reasons, they have been admitted to hospital either voluntarily or sectioned. If their cigarettes are taken off them as well they are going to feel victimised even more. I do appreciate that non smokers are entitled to a smoke-free environment, but surely common sense should come into it as well. After all a ward is the only home a lot of mental health patients are going to know for a while. A wee corner should be found somewhere for smoking patients to be able to have a puff.
Andrea Brown, Ayr