An interesting survey has been published by the Foundation for Mental Health. It’s called “Death of the smoking den, The initial impact of no smoking legislation in psychiatric units in England in 2008.”

In the introduction to the report, Louis Appleby, the National Director for Mental Health is quoted as having said in 2007 “The rest of the NHS is going smokefree. What message would an exemption for mental health wards send out about the importance of the lives of mental health patients?”

However, the survey uncovered widespread problems with the implementation of a smoking ban in psychiatric units in England. Most respondents indicated the ban had been only partially effective, with only 15.6% of responding units claiming complete effectiveness.

It’s an interesting area, and one deserving of more research. I’d like to know what patients think of the ban. Part of the problem is that some patients are admitted on an involuntary basis to psychiatric wards.

It is easy to see why the stress of being very unwell paired with that of not being allowed to leave, never mind smoke could end up seeming like both an intolerable violation of personal liberty and an immediate difficulty in trying to build therapeutic relationships with staff. In short. this would not seem the ideal time to stop smoking.

In many other areas of challenging behaviour, compromises are made, for example methadone substitution for heroin, the supply of clean needles for intravenous drug use or sterilised equipment for people who are driven to cut or harm themselves.

Without necessarily agreeing with any of these, I think it’s crucial that nurses should be able to use their professional judgement as regards smoking cessation for their psychiatric inpatients.