Smoking and mental health - NCSCT

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Smoking and mental health presenting mental health problem as the key priority for each patient, and the need to do so without resort to coercive means, inasmuch as this is possible. A balance needs to be struck that permits a reasonably flexible approach to be taken, which encourages smoking cessation (or temporary abstinence) without resort to force or threat. Exactly how this balance is to be struck requires judgement and experience, eg taking into account the needs and welfare of staff and other patients, how far should a mental health institution seek to accommodate patients’ smoking by allowing staff to accompany patients outside to smoke? And how far should institutions mitigate the effects of going outside in terms of exposure to the elements or managing security risks by building shelters or secure outdoor smoking areas? There is no precise and one-size-fitsall answer to these questions. But the central principle here is clear, which is that smoking is hazardous to health, including mental health, and a well-thought-out care plan needs to reflect best practice in smoking cessation as part of good care. 9.4 Access to treatment for smoking Turning from policy towards clinical management of the smoking behaviour of patients, we now need to consider access to treatment by smokers with mental disorders. Starting from the obvious premise that smoking is just as important a health risk in someone with a mental disorder as it is in anyone, there is no reason to place any barriers in the way of someone who wants to quit. Thus someone with a mental disorder, in or out of formal mental healthcare, should have the same access to advice, counselling, cessation pharmacotherapies and harm reduction interventions as the general population. One troubling feature of the Foster case cited above is that the court did not acknowledge the difference between taking away cigarettes as removal of a privilege, and denying access to NRT as a treatment. An opportunity to help a young man to quit smoking was missed. In light of the CL and Chadwick Lodge cases, it appears sensible to ensure that alternative sources of nicotine are readily available, and where appropriate prescribed, for smokers obliged to abstain from smoking while in smoke-free facilities. However, as the CL case shows, careful consultation is needed before such policies are adopted, because nudges and incentives can be acceptable, but coercion is not. 6 This approach does no more than suggest that we integrate smoking cessation support into mental healthcare, especially in residential settings. However, we may go further; given the evidence that we have on not only the higher prevalence of smoking in people with mental health problems but also the greater difficulties that they face in quitting, it is arguable that making treatment accessible and effective requires specific additional investment. The need for support is greater; the type of intervention needed may be more intensive or of longer duration. Smoke-free policies in mental health institutions, as in other public places, are justified because of the health and wellbeing of non-smoking 186 © Royal College of Physicians 2013
Ethical and legal aspects 9 patients and staff. The moral imperative of healthcare institutions to promote the mental and physical health of their patients (and to protect and support the mental and physical health of their staff) makes a shift in culture within mental health institutions away from one that supports smoking. But supporting smoking cessation should take note of the general approach to each patient’s care. Coercion will rarely be justified. In the very specific circumstances of highsecurity facilities, security will necessarily take priority over patients’ wishes to go outside to smoke. But applying smoke-free policies in these circumstances is not forcing patients to give up smoking for the sake of giving up smoking. Rather it is applying the necessary security measures in a situation where protecting the health and wellbeing of others (in this case through application of a smoke-free policy designed to protect others) is a priority in any case. 9.5 Summary > The entitlement of people with mental disorders to smoking cessation support is at least as strong as for those of the general population. > Their needs for such support are in many cases actually greater. Patients with mental health problems should receive at least the same level of access to smoking cessation treatment and aids to quitting as members of the general population. > The objectives of smoking cessation and tobacco control policies in the mental healthcare context need to take account of the complexity of the care needs of people with mental health problems. > The case law relating to smoking policies in formal mental healthcare settings and prisons suggests that a careful balance needs to be struck between personal rights and welfare, the objectives of the institutions, and the rights and interests of other staff and residents/inmates. > There is a need for greater investment in smoking cessation treatment in the mental healthcare context. > Smoke-free policies in mental health institutions, as in other public places, are justified on the grounds of health and wellbeing of non-smoking patients and staff. > The moral imperative of healthcare institutions to promote the mental and physical health of their patients (and to protect and support the mental and physical health of their staff) justifies a shift in culture within mental health institutions away from one that supports smoking. References 1 McNally L, Oyefeso A, Annan J, et al. A survey of staff attitudes to smoking-related policy and intervention in psychiatric and general health care settings. Journal of Public Health 2006;28:192–6. © Royal College of Physicians 2013 187
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PDF not for circulation Smoking and
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Contents Members of the Tobacco Adv
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Contents 4.4.3 Attention deficit hy
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Contents 6.4.3 Staff knowledge 122
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Contents 10.5 Tobacco policy and me
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Contributors Anthony Aclet - Specia
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Contributors Jill Williams - Associ
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1 Mental disorders 1.1 What is a me
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Mental disorders 1 1.3 Common menta
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Mental disorders 1 1.4.4 Somatisati
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Mental disorders 1 In addition to s
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Mental disorders 1 not diagnosed un
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Mental disorders 1 Similar to many
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Mental disorders 1 12 Chang CK, Hay
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Mental disorders 1 52 Young S, Toon
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Smoking among people with mental di
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Smoking cessation interventions for
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6 Population strategies to prevent
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Population strategies to prevent sm
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Smoking and mental disorders: speci
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Smoking and mental health - NCSCT

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