Should Psychiatric Patients be Allowed to Smoke?

Image via Flicker user Ed Schipul

Let’s get the obvious out of the way: Smoking is bad for you. It causes blindness, heart disease, is one of the primary causes of cancer and leads to strokes. A single cigarette contains tar, arsenic, lead, and four thousand other chemicals—as well as nicotine. And there’s the burden on taxpayers, as at least half of smokers wind up in the public health system or die. Then there's second-hand smoking which kills over 4300 hundred Kiwis each year.

New Zealand was one of the first nations to pass legislation banning smoking in indoor workplaces. The Smoke-free Environments Act was amended in 2003 to apply to all workplaces—be they bars, cafeterias, factories, or dedicated “smoko rooms”. It was banned in all schools and areas related to child-care. Then in 2011, a complete ban of smoking in prisons came into effect under the Act, legislated by Corrections Minister Judith Collins. It's approximated that 67 percent of prisoners smoke and the New Zealand Medical Journal claims: “Prison arguably presents an ideal opportunity to quit smoking as its restricted environment reduces the possibility of accessing cigarettes and exposure to tobacco marketing.” Many inmates, aleady facing the shame of serving a prison sentence, dealing with the possibility of abuse, trauma, the indignities of being detained, felt differently.

The ban on smoking at hospitals, which was applied under the same Bill, was seen as a no-brainer. However, the inclusion of hospital psych wards in that ban is where things get complicated. To an individual battling florid psychosis, schizophrenia, intense mania, or severe debilitating depression, smoking can provide a rare comfort. And while nicotine replacement therapy is offered: gum, lozenges, and inhalers—according to a charge nurse at the primary psychiatric facility in Auckland Central—these measures are not government-funded.

Jo Galvin, a former inpatient at a psych ward in Auckland commented: “It's fucking shit… it just made it harder being there, and it was already shit feeling shit and being there. I'd been in a ward in the UK and I could smoke there and it was better for morale. And you could kinda bond with other patients because of the smoking. I was just so much more stressed, anxious and bored. In Galvin's case, the inability to smoke only served to exacerbate her distress. Galvin also commented that she noticed more aggression in patients who smoked but now found themselves unable to. Kevin Ng, also incarcerated, felt: “more violence took place because smokers weren't able to just have a ciggie.”

In Hillmorton Hospital, some psychiatric patients objected to the new legislation. A mother of one of these patients told Rebecca Todd she was unhappy her son’s right to choose had been denied. "Just because you are incarcerated doesn't mean all your individual rights can be obliterated and trampled all over". Similarly, a therapist in the Auckland District Health Board Mental Health System noted they were shocked when the bill got passed as it was a “violation of human rights.” Although he retracted slightly saying, “it cuts both ways though. I’ve known many inpatients start smoking while they were in the ward.”

In the debate transcript over the Bill in 2011 that enforced the smoke-free policy in prisons and hospitals, Iain Lees-Galloway, of the Labour Party said: “It gives me a lot of pleasure to rise and offer Labour’s enthusiastic and wholehearted support for the Smoke-free Environments (Controls and Enforcement) Amendment Bill. This bill is an important step on the path towards achieving a smoke-free nation by 2025, a path that this nation has been on for a number of years.”

But it does beg the question whether a promise of a smoke-free nation isn’t a veiled threat that in a little over ten years we will no longer have the right to smoke. Nicotine isn't an illegal drug: like caffeine, sugar, junk food and other vices it is addictive, induces a  dependency, and can become imperative for individuals to function.

Smoking is unhealthy and expensive. Yet, particularly in places like prisons and psych wards, it's a an activity that can alleviate distress and aggression. And it, like a lot of the dumb things we do, is an individual choice. Because what we do, and don’t do with our bodies isn’t a matter of legislation. With regard to these laws, Dr. Jin Teoh, a former registrar, said the Act is good because “it effectively stops the messaging that smoking is the norm, is better for workers who otherwise would have to passively smoke, and helps maintain people who have worked hard to quit. Having said that, I do think it's really difficult for people in psych wards and prisons to quit when they have all this other stuff to deal with, so I think if psych patients are addicted and need a smoke they could go one-to-one with a nurse escort out of the grounds…” Institutions need to figure out what to do, and there could be workarounds, to resolve the quiet desperation smokers face whilst incarcerated.