May 21, 2008
by Angela Hussain

Almost every patient opposes a total smoking ban inside mental health units, according to research in one NHS trust.

The findings published in this month's Psychiatric Bulletin journal are likely to further the debate as to whether an outright ban of smoking in psychiatric units is justified.

Three psychiatric patients detained in Rampton top security hospital in Nottinghamshire yesterday lost a high court test case for the right to continue smoking. Judges ruled the ban was justified for "health and security" reasons.

It is estimated that 70% of patients in psychiatric hospital smoke, and 50% are heavy smokers. This compares with 25% and 9%, respectively, of non-patients.

In a survey of 135 inpatients on 13 mental health wards at Mersey Care NHS Trust, just three per cent supported a complete smoking ban inside and on hospital premises.

One in ten (14%) thought there should be a complete ban inside only. Seven in ten (71%) supported having designated smoking areas.

Smoking was banned last year in all enclosed public and work. A exemption for mental health units ends on July 1. Until then, they may continue to have a designated smoking room.

While 90% of the general public believe smoking should be banned in public places, only 50% of the study's patients agreed.

Two years ago Kings Fund research found almost all mental health nurses do not want smoking banned in psychiatric wards, often because they fear that it would spark aggression from patients.

Smoking policy should be ?more lenient? in psychiatric units, argue the authors of the Psychiatric Bulletin study.

Drs Jennifer Smith and Charlotte O?Callaghan suggest psychiatric units should either build external unenclosed smoking shelters or an outdoor smoking area leading off from, and visible from, wards. This would mean that patients deemed too ill to go outside would still be viewable when smoking.

"The fact that this study showed a large difference between those wanting a total smoking ban inside hospital buildings (14%) and those supporting the government ban on smoking in public places (54%) may reflect views that smoking policy should be more lenient in psychiatric units,? wrote Drs Smith and O?Callaghan.

Human rights lawyers acting for Rampton patients had argued that they would be the only group of people in the country banned from smoking "in the privacy of their home", because, unlike patients at other hospitals, many were not allowed outdoors to smoke.

Barrister Paul Bowen said others whose homes are in public spaces, such as soldiers and care home patients, will still be able to smoke under special exemptions.

But Rampton patients face a total ban that amounts to unfair and unlawful discrimination, he said.

The patients were refused permission to appeal, but can still ask the court of appeal itself to consider their case because of its important legal implications.

The judges also rejected allegations that the smoking ban, introduced at Rampton in April last year by Nottinghamshire Healthcare NHS Trust, was inflexible because no exemptions had been granted.

Evidence showed the ban was not having a de-stabilising effect on patients, said the judges.

Lord Justice Pill said: "There is very strong evidence that smoking causes disease and endangers the health of the smokers themselves and other people who live and work in their vicinity."

The judge added the smoking ban was also justified by security difficulties posed by allowing patients - many of whom have "dangerous, violent or criminal propensities" - to smoke outside in Rampton's grounds.

"Like other hospitals, it is smoke-free. Both health and security considerations justify the ban even though smoking in the grounds, which may be possible at other hospitals, is not feasible at Rampton," said Lord Justice Pill in a decision made with Mr Justice Silber.

Patients can be detained at Rampton for years.

See also:
March 20, 2008: Psychiatric patients launch test case for right to smoke while detained - patients could be only group of people banned from smoking "in the privacy of their own home", judges told

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