Psychiatric Hospital Smoking Bans: Debated

Cigarette smoking bans in psychiatric facilities debated by experts


Should psychiatric hospitals ban smoking among patients both indoors and out? Some experts disagree on whether bans like these would do more harm than good.

In a recent article, Deborah Arnott, chief executive of Action on Smoking and Health, and Simon Wessely, PsyD, the president of the Royal College of Psychiatrists, went head-to-head with Michael Fitzpatrick, MD, on this issue.

According to Arnott and Dr. Wessely, smoking bans in psychiatric hospitals lead to better treatment engagement and encourage patients to quit. The disproportionate harm caused by smoking among patients with serious mental health problems also justifies these bans.

Arnott and Dr. Wessely go on to explain that patients with serious mental health problems are likely to die up to 17.5 years earlier than the general public, primarily because of smoking-related diseases. And smoking rates among people with serious mental health problems are triple that of the general public, according to these experts.

"Smokers with mental health disorders are as motivated to quit smoking as the general population, and quitting has been shown to improve mental as well as physical health," wrote Arnott and Dr. Wessely. "Quitting also enables smokers to take lower doses of [psychiatric] drugs and hence experience fewer side effects."

In spite of this, these experts say smokers in psychiatric hospitals are less likely than other smokers to be offered help to quit.

Arnott and Dr. Wessely point to an example of one hospital that initiated a smoke-free trial. This hospital found that the smoke-free rule led to better patient engagement and cut down the amount of time staff spent supervising patients. The rule also led to less marijuana use and violent smoking-related incidents among patients.

However, Dr. Fitzpatrick argues that smoking bans are unethical because they deprive patients of autonomy and impose unsolicited treatment.

"Smoking restrictions already imposed in psychiatric services have caused distress to patients and conflict with staff," Dr. Fitzpatrick wrote. "This approach is heartless and inhumane as well as degrading to their humanity. Furthermore, it will likely deter people with mental illness from seeking access to services."

According to Dr. Fitzpatrick, all patients — regardless of diagnosis — should be entitled to make their own choices in matters affecting their health. He also notes that exercising independent will is important to the recovery of psychiatric patients.

He concludes that, "Patients attend mental hospital for treatment of their mental illness, not for programs of moral improvement or health promotion. Psychiatric health workers should concentrate their energies on the treatment of mental illness and leave decisions about wider health matters to those entitled and qualified to make them — the patients."

This article was published Nov. 4 in the journal The BMJ.

No funding sources or conflicts of interest were disclosed.