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About the Issue.

Australian hospitals are forcing involuntary mental health patients to quit smoking against their will. Total smoking bans increase distress for people already in severe crisis, damage recovery & create dangerous risks.

This campaign aims to repeal these bans, re-establish smoking areas in suitable outdoor hospital areas, and establish sensible, voluntary quit programs that actually work.

1. This cause is not about promoting smoking behaviour.
At its heart, this cause isn't even about smoking. It’s about human rights, freedom of choice, a paternalistic expansion of ‘duty of care’, and not kicking people when they’re down. It’s about getting help to deal with distress, rather than having our distress increased by the health system. We all know smoking isn't such a great idea. Most of us would like to quit, and most of us even welcome some support – but we don’t want or need to quit by force, or in the midst of a crisis.

2. The smoking bans can be lifted without risking non-smokers.
Psychiatric wards have outdoor areas in which people can smoke with relatively little impact on staff or non-smoking patients. The Tobacco Act allows for smoking in uncovered, outdoor areas, as well as for approved mental health facilities. And at a relatively low cost, ‘Perspex’ smoking shelters can be installed in these areas – preventing any passive smoking impact. Compare the once-off cost of shelters to the ongoing cost of time spent by nurses to enforce smoking bans, and it’s a ‘no-brainer’.

3. Smoking bans damage therapeutic relationships.
Consumers do not trust staff members who are policing cigarette smoking. This in turn leads to fewer opportunities for support and recovery.

4. Prohibition creates social inequities, crime and violence.
Health authorities should discourage smoking. But history tells us that discouragement is very different to prohibition. Prohibition has never worked. Already in response to these bans we see an underground trade in cigarettes which includes stand-over tactics and violence amongst one of our most vulnerable social groups. We see people taking unsafe risks in order to smoke. Discourage smoking, by all means, but be willing to adapt and compromise on reasonable limits which do not encourage crime and danger.

5. It is not the place of the health system to enforce behaviours.
Educating people about how to improve their health and quit is a great thing. Forcing people to quit – particularly when they're at their most vulnerable and distressed – is wrong. It crosses a line, and sets a precedent in our health system which is contrary to human rights principles. There are many other areas where healthy behaviours could also be enforced – diet, exercise, healthy relationships, risky sports activities - where is the line?

6. By the way, it doesn’t work.
Multiple studies show that enforced smoking cessation programs in psychiatric settings do not work. One study showed that over 90% of patients lit a cigarette within 5 minutes of discharge. So what is this policy achieving besides increased distress and risk?

7. Worse, it causes harm.
Harm #1: Many smokers with mental health issues now refuse to seek help from psychiatric hospitals during a relapse or crisis. The fear of having their cigarettes taken away, on top of everything else, is just too much. This leaves people at risk of self-harm and suicide.

Harm #2: Cigarette smoking interacts with dopamine receptors in the brain. Multiple studies show that people with mental health issues use smoking to reduce negative side effects of medication, and also as self-medication. Smoking can have a positive effect on motivation, active coping, environmental attention and engagement and emotional responsiveness. Quitting smoking while in an acute psychiatric episode increases distress.

Harm #3: People seek treatment to be relived of distress during a mental health crisis, not to have their distress increased.

Harm #4: Cigarettes interact with the way in which our bodies metabolise many psychiatric drugs. Quitting smoking can change the way our bodies process medications.

8. We can help people to quit – if we do it right.
We all want to support better health. So let’s encourage quitting when people are at their best, not their worst. Outpatient and community services are well placed to run voluntary smoking cessation programs – let’s use them for that. Let’s continue to offer smoking cessation programs in wards as well – but make them voluntary. Numerous studies and experts will tell you that people only successfully quit an addiction when it’s their choice. So let’s work together to increase the choices.

Please show your support for this cause.

10 comments:

  1. Finally someone that gets it, had sister admitted to Greylands in WA her sole focus was having on visitors so she could go outside and have a smoke. The smokes she took back inside were more valuable than gold or coffee. within 2 steps of the door on discharge she had a smoke lit. The staff knew and supported it, not sure if they knew about the ones being snuck in though.

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  2. Thanks for sharing your sister's experience. Unfortunately this is not uncommon - I know of many family members and friends who have to 'sneak' cigarettes onto wards for their loved ones.

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  3. Isabell Collins27 June 2011 at 23:18

    To stop people smoking when they are at their most distressed is cruel and inhumane. Either the in-patient services are not aware of the level of distress their patients are experiencing or they don't care about their distress. Either way it is an indictment on mental health services that they would do this to their patients at such a time.

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  4. Thanks Isabell - we are in violent agreement! I know that many of the nurses 'on the ground' disagree with the bans. HACSU, the union which represents many psych nurses, tell me that the bans are a frequent topic of conversation amongst members, with many feeling they are a human rights violation for patients. They see the distress, and the risks, and they don't want to enforce them - but their organisations require them to do so. I am particularly outraged that many nurses employment contracts have 'gag clauses' which forbid them from speaking out publicly against hospital policies. This denies consumers the ability to publicly access the support of nurses. Thankfully, some brave nurses are starting to speak out on this issue. I might be wrong, but it seems to me that the biggest part of this issue is with hospital management, and decision makers in the department - all of whom seem to be completely out of touch with the real impacts of these bans. I also see a complete lack of respect for consumer needs and wishes, and a very black and white interpretation of a complex issue. It is indeed an indictment - particularly at a time when services claim to be increasing access!

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  5. What needs to be understood is that quitting is a massive undertaking and cannot be achieved in times of trauma. I'm in the process now and struggling hard.
    My doctor once told me not to give up at that time, as I was so troubled by other problems.
    I waited until the time was right... why traumatise a patient so badly when you are supposed to be healing them?

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  6. Four years ago at an AAU there were just as many badly behaved smokers, who were allowed to smoke at that time, as there were last year when I was at the same unit, when they were not. Maybe some education about manners might be appropriate.

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  7. I'm a med student and whilst I know I should be super anti-smoking (and to be fair, I generally am) I feel the NSW health laws are completely unjust. A person who has had their leg amputated secondary to the effects of peripheral vascular disease (caused from 50 years of smoking) can sit out the front of the hospital in their wheelchair and happily light a cigarette but a mental health inpatient can't!!?? It seems incredibly unethical and unjust to me.

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  8. The worst part of this whole deal is that it is going to put a barrier between the health care personnel who have to enforce (or at least are told to enforce) the No Smoking ban and their patients. The consequences for the health care staff not invoking this mandate are probably not going to be fair either. It seems that there has to be some common ground here and that common ground is the "designated smoking areas". Come on people, let's be sensible about this, even the V.A. in the U.S. has adopted this policy, and we all know how screwed up the Veterans Administration in the U.S. is. Or at least you've heard of how screwed up it is. Don't put more pressure on people who are already stressed out by putting a monkey on their back. They don't need the monkey, they are already carrying around enough weight - as are the caretakers. Thank You. U.S. Armed Forces 1964 to 1968. Vietnam Veteran.

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