Smoking and mental health - NCSCT

Smoking and mental health
full justification, rather than that the patients’ liberties are automatically curtailed
with particular freedoms being granted ad hoc or as privileges.
At the time of writing, patients of Chadwick Lodge hospital in
Buckinghamshire are petitioning the High Court to overturn a ban on smoking
on hospital premises outside and off hospital premises while escorted by a
nurse. 4 The news report on this case quotes a spokesman for the hospital as
saying that this was a part of a healthy lifestyle policy for patients, and also that
the policy followed from the N case. Yet whereas Rampton is a high-security
hospital and smoking outside is not possible for patients there, Chadwick Lodge
is a medium-security hospital and smoking outside was, until the adoption of the
policy, permitted. It will be interesting to see whether the approach in the CL
case is followed.
In the rather different context of a young offenders’ institution, an inmate was
unsuccessful in challenging a decision of the governor to remove his cigarettes as
part of a removal of privileges as a disciplinary measure (R(Foster) v HMP
Highdown [2010]). In the criminal justice system, unlike in the hospital system, it
is clearer that many ‘rights’ may be granted or suspended as part of the nature of
detention. However, the interesting feature of this case was that the applicant
argued that the punishment was unduly severe because it imposed withdrawal
symptoms upon him, and he should have been given nicotine replacement
therapy (NRT). It is interesting to speculate whether, had he succeeded, the
approach that mental hospitals of the medium- or low-security type could take
would be to ban smoking but supply NRT as part of treatment in a more
systematic way than at present. (In the case of Shelley v United Kingdom [2008],
the issue of provision of clean needles for harm reduction in illicit opiate drug
use in prison was considered, with the English courts and the European Court of
Human Rights concurring that there was no obligation to provide needles. The
case is discussed in Coggon. 3 )
What these cases illustrate is that, from the point of view of the courts, the
policies that hospitals (and prisons) may adopt to promote the health of their
patients (and inmates) and protect the health of others (staff, other patients and
inmates, visitors) must strike a careful balance which takes into account the
overall purpose of the institution, the rights of those who live and work there,
and, particularly in hospital settings, the need for careful consultation. The case
law also illustrates the important fact that society at large has not reached a stable
consensus on how far a smoking ban can be an important restriction on personal
freedom and how far it may cause genuine distress, discomfort or suffering.
9.3 Population and individual arguments
From a population perspective, there is no good reason to think that smoking is
any less important to the health of a person with a mental disorder than to
anyone else, or that quitting would be any less beneficial. Given that, for more or
184 © Royal College of Physicians 2013