Head To Head Maudsley Debate

Should psychiatric hospitals completely ban smoking?

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5654 (Published 04 November 2015) Cite this as: BMJ 2015;351:h5654
  1. Deborah Arnott, chief executive, Action on Smoking and Health (ASH), London, UK,
  2. Simon Wessely, president, Royal College of Psychiatrists, London,
  3. Michael Fitzpatrick, former GP and writer, London
  1. Correspondence to: D Arnott Deborah.Arnott{at}ash.org.uk, M Fitzpatrick fitz{at}easynet.co.uk

A “smoking culture” leads to disproportionate harm among people with serious mental health problems, argue Deborah Arnott and Simon Wessely. But Michael Fitzpatrick thinks it unethical to deprive patients of autonomy and impose treatment

Yes—Deborah Arnott, Simon Wessely

The harm caused by smoking justifies prohibiting smoking throughout psychiatric hospital premises. If you have serious mental health problems you are likely to die up to 17.5 years prematurely, primarily because of diseases caused by smoking.1 In Britain today about one third of cigarettes are smoked by someone with a mental disorder, and smoking rates among people with serious mental illness are triple that of the general population.1 Where smoke-free policies do not exist, patients have reported that the smoking culture led to them taking it up or to relapsing back to smoking after quitting because everyone else was, and there was “simply nothing else to do.”2

Quitting improves health

Smokers with mental health disorders are as motivated to quit smoking as the general population,1 and quitting has been shown to improve mental as well as physical health. Quitting also enables smokers to take lower doses of neuroleptic drugs and hence experience fewer side effects.1

Despite all this, smokers in psychiatric hospitals are less, rather than more, likely than other smokers to be offered help to quit.1 In the past two decades, during which the prevalence of smoking throughout society has fallen by a quarter, smoking rates among people with serious mental illness have barely changed.1

Prohibiting smoking indoors is clearly justified to protect non-smoking patients and staff, but is it a step too far to prevent inpatients from smoking outdoors as well, and in so doing effectively force them to quit smoking?

The legal position was tested in the English courts when Rampton secure hospital went …

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