BMJ  2006;333:551-552 (9 September), doi:10.1136/bmj.333.7567.551-c

Letter

Exempting mental health units from smoke-free laws

Issue should no longer be ignored

EDITOR—Campion et al wrote on no longer exempting mental health units from smoke-free laws.¹ By allowing smoking in psychiatric units the government will only increase stigma towards psychiatric patients when the Royal College of Psychiatrists is trying hard to reduce it.

Admission of smokers with mental illness to smoke-free psychiatric units may lead to behavioural deterioration, but some evidence from the United States refutes this argument. In 1987 the Board of Trustees of Southwest Washington Hospitals instituted a smoking ban in all of its facilities, including general psychiatry units. The changes were introduced successfully with minimal impact on the successful function of the psychiatric service.² The implementation of a smoking ban, establishing a smoke-free psychiatric service and abolishing tobacco products, created minor management difficulties on a locked psychiatric unit.³

The effects of prohibiting cigarette smoking on the behaviour of patients on a 25 bed psychiatric inpatient unit were assessed immediately after implementation of a smoking ban and two years later. No major behavioural disruptions were observed after the ban. The number of calls for security assistance, physical assaults, instances of leather restraints and of seclusions, and discharges against medical advice did not increase significantly immediately after the restriction on smoking or two years later.⁴

Signs and symptoms of nicotine withdrawal and alterations in psychopathology were evaluated among acutely ill psychiatric patients admitted to a hospital with a smoking ban.⁵ Despite subjects' reports of feeling distressed and of experiencing nicotine withdrawal symptoms, abrupt cessation of smoking did not significantly affect either the severity or the improvement of psychopathological symptoms during admission. The authors report no compelling reasons to reverse the smoking ban.

With the growing concern for the harmful effects of cigarette smoking and passive smoking and the evidence above, exemptions for mental health units from smoke-free laws can no longer be ignored.

Royal Preston Hospital, Preston PR2 9HT docftalam{at}aol.com

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Competing interests: None declared.

References

1. Campion J, McNeill A, Checinski K. Exempting mental health units from smoke-free laws. BMJ 2006;333: 407-8. (26 August.)[Free Full Text]
2. Thorward SR, Birnbaum. Effects of a smoking ban on a general hospital psychiatric unit. Gen Hosp Psychiatry 1989;11: 63-7.[CrossRef][ISI][Medline]
3. Ryabik BM, Lippmann SB, Mount R. Implementation of a smoking ban on a locked psychiatric unit. Gen Hosp Psychiatry 1994;16: 200-4.[CrossRef][ISI][Medline]
4. Velasco J, Eells TD, Anderson R, Head M, Ryabik B, Mount R, et al. A two year follow up on the effects of smoking ban in an inpatient psychiatric service. Psychiatr Serv 1996;47: 869-71.[Abstract/Free Full Text]
5. Smith CM, Pristach CA, Cartagena M. Obligatory cessation of smoking by psychiatric inpatients. Psychiatric Services 1999;50: 91-4.[Abstract/Free Full Text]

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Relevant Article

Exempting mental health units from smoke-free laws

Jonathan Campion, Ann McNeill, and Ken Checinski
BMJ 2006 333: 407-408. [Extract] [Full Text] [PDF]