October 29, 2007

Patient-Rights and A Possible Smoking Ban

In the past, we've discussed the use of nicotine and its effects on schizophrenia. Some of these are positive and include its ability to improve the processing of external stimuli and combat the sedative side effects of some antipsychotic medications. However, it has also been found that people living in public institutions who suffer from mental illness are more likely to die sooner (25 years or so) than the rest of the population and these deaths are often linked to smoking-related causes. Perhaps in an attempt to ameliorate this situation the state of Connecticut plans to ban smoking on the premises of one of its psychiatric hospitals. A new story focuses on this possible ban and its implication for patient-rights:

The Connecticut Valley Hospital was supposed to have undergone a tobacco ban starting the first day of October. But "just before the state Department of Mental Health and Addiction Services was about to implement...(the) ban at CVH...several...patients filed a federal lawsuit claiming that this measure would violate their civil rights. Since then the department has opted to hold off on implementing the ban until 'there is greater clarity around the lawsuit'..." Currently, the state has requested a dismissal of the lawsuit claiming, "'the doctrine of equal protection does not apply when there is a recognized interest in protecting people from secondhand smoke' and when people are in a 'limited space and cannot readily or voluntarily leave.'" The patients who filed the lawsuit are protesting the state's claim by stating that CVH only allows smoking in outside areas and as a result, patients who don't smoke aren't exposed to it.

The possible ban and lawsuit bring up, once again, the issue of nicotine and mental illness. As we've recently covered, people with schizophrenia are more likely to suffer from both heart and cardiovascular disease. A major risk factor for both of these conditions is smoking. We already know that a large percentage of the mentally ill population smokes: recent reports show that between 50 and 80 percent smoke. Considering this, we can understand why a ban was proposed. On the other hand, and as already stated, nicotine has been shown to have positive effects on people with schizophrenia and other mental illnesses. In the past we've dealt with the problem of smoking and schizophrenia by first pointing out that nicotine does in fact aid schizophrenia by reducing certain symptoms, but by also stating that smoking increases the risk for an earlier death. We've suggested cessation at the risk of increased symptoms and also other methods of nicotine use besides cigarettes. One of our suggested methods is snus, which is a cheaper and healthier option than cigarettes.

The story also discusses the important issue of patient-rights. When someone is afflicted with mental illness and living in a psychiatric facility, does the government have the right to take away their decision to smoke? Most staff at CVH argue "no." They state that the choice to smoke is an independent decision and one of the few, patients at CVH are allowed to make alone. Taking this choice away, which historically has been instituted in many psychiatric facilities as a "behavior model tool" and a reward for good behavior may mean taking away one of the few freedoms, which, many mentally ill patients who are involuntarily committed to facilities like CVH for years are allowed. Another option may be to retain the freedom of choice in regards to smoking while informing and educating patients about the serious negative consequences of smoking and thus perhaps attempting to move toward a lower to no smoking mentally ill population. It seems important to stress the fact that CVH is the type of facility where patients live for many years, thus taking away their ability to smoke won't be for just a few days until they return to the freedom of their own homes. In the case of the Connecticut Valley Hospital, many of the patients are home.

Full Story: Hartford Courant, Lighting Up When Home Is A Hospital
Office of Protection and Advocacy for Persons with Disabilities (Connecticut)


We have had a smoking ban in public spaces such as the work place and bars in the uk for a few months ,this also includes hospitals and clinics..i haven't had any feed back on how people have reacted in the acute and long stay wards ...but i can imagine its not very popular ...many people chain smoke when they are having an episode in hospital.I'm glad to say i have finally kicked the habit.

Posted by: Salty Davis at October 29, 2007 04:37 PM

Difficult call. To ban or not to ban. With rising health care costs, some of which is due to excessive billing by medical care providers to insurance companies, and the obvious fact that smoking is dangerous to personal and MAYBE public health. At what point are we going to stop taking away personal choice. Sure life may be shorter, but in the words of Elvis, "I did it my way". Tough call all around. Maybe a smoking ban will stop some from smoking, but it won't stop all. Just look at what the war on drugs has done, created micro criminal economies. I think education is the cure, banning is flagrant and unnecessary. LISTEN TO THOSE WHO SMOKE as well as those who care not too.

Posted by: mister_lister at October 29, 2007 07:07 PM

It also shows how instutions need to change in order to treat people as best as possible.
If someone has for example be deemed mentally i'll after commiting a crime then by law its not that persons fault and if you think it is that persons fault then you have a problem with that legal decision and not how abuse and other poor treatment should go on in such an institution.
Also others need to be let out sooner and where possible drug intake needs to be minimised or even removed.
Caring for people as a whole in these institutions better would lead to better life expectancies also but yes some people in these institutions can be serverly disturbed and it's still hard today to know what to do with them accept to overpower with drugs and comformt with ciggerets.

Posted by: Luke Andrew Marsh at October 30, 2007 03:26 AM

My son, a non smoker, shares a house with two other, chain smoking mental health clients. The whole house stinks. The habits of the other residents are subjecting him to a serious health risk so that my son cannot use most of the building. He spends all day out of the house looking for smoke free venues - sometime he just walks the streets to get away from this smokers hell.

The new smoking ban in the UK has made matters worse because the two chain smokers can no longer smoke in their public houses.

Apparaently we can do nothing about this. Our son has no right to clean air under the law.

Posted by: John Sutton at October 30, 2007 03:40 AM

In my opinion it's cruel to deprive SZ patients of their cigarettes which often has a calming effect on them. Our local hospital has tried to implement a ban on smoking on the entire hospital grounds but it has been so unsuccessful that they have ended up creating an outdoor, under cover area for smokers (most of whom are hospital staff)....go figure! The only ward where smoking is officially allowed (outside in the garden) is the psychiatric ward. It's been my experience that you can't force people to your point of view. Encouragement & help works better.

Posted by: Glesgalass at November 1, 2007 11:53 PM

This is a classic two sided issue, especially for mental health housing. This has evolved from One flu over the Coo Coo nest where people in mental health housing were playing poker for cigarettes. Imagine taking away cigarettes from them in there era. Taking away smoking to them is like taking away candy from a baby.

But as time evolves like all the changes that happens to PWD so do laws. Their many people who are working out and giving up smoking. I see it as giving that extra push to give up cigarettes to vulnerable people can ultimately make them healthier, live longer, save more money and build more self-esteem.

Time change, people change and so can laws.

Posted by: JD at November 2, 2007 10:39 AM

Post a comment

Please enter this code to enable your comment -
Remember Me?
(you may use HTML tags for style)
* indicates required