British government officials are urging all low and medium security mental health units to go ‘smoke free’, effectively forcing patients off cigarettes. Clinical experts warn that making patients quit against their will is illegal, contravening the Mental Health Act and setting a precedent that could see all sorts of health procedures inflicted upon mental health patients against their wishes.
New figures show that one in three people with a mental health issue smoke, a rate which is markedly higher the general population’s rate of 18.5 percent. In addition, Public Health England (PHE), the body behind the move, has conducted a survey of NHS mental health facilities and found that 64 percent of patients in those facilities smoke.
PHE is using these figures to wage war on smoking in mental health units, urging them to go “smoke free”, which they claim will improve the mental health of patients and save up to £40m a year in psychotropic drugs. The latter claim is based on the suggestion that smoking can interfere with drugs, necessitating much higher doses to be prescribed to offset the effect.
Matthew Day, author of the PHE’s report justifying the policy has insisted that “service users (patients) are just as likely to want to stop smoking as the general population, and can do so when offered support.” However, health authorities are going one step further than merely supporting people who, of their own volition want to give up smoking.
Some units have already forced patients to cease smoking immediately upon arrival. PHE wants the rest to follow suit, in line with National Institute for Health and Care Excellence (which bears the Orwellian acronym ‘NICE’) guidelines stipulating that units should be smoke free.
Mary Yates is the Modern Matron at the South London and Maudsley NHS Foundation Trust (SLaM) which runs four such facilities. She said: “Since going smokefree in October 2014, SLaM has demonstrated that when patients and staff are given appropriate support, the long standing culture of smoking in mental health services can be broken.
“All SLaM patients are now screened for smoking status at the first contact and offered appropriate help to make a quit attempt or abstain whilst in the smokefree hospital environment.
“Our staff have reinvested time previously spent facilitating smoking, to the provision of therapeutic activities which support health and wellbeing. The benefits to everyone have been significant.”
Ms Yates was happy to be interviewed for a Radio 4 Today segment on the new guidelines which aired on Thursday morning, during which BBC reporter Sima Kotcheta confirmed that, at the Trust’s facilities, “If you’re a patient here, you can’t smoke”.
Ms Yates also appeared on the Jeremy Vine show on BBC Radio 2 later that day, confirming that patients at her units are prevented from smoking upon being admitted. “What we’ve promised to our patients is that within thirty minutes of their admission, if they’re a smoker, we’ll make sure we have the nicotine replacement ready and waiting for them. Our cupboards are full of patches, inhalators, lozenges, whatever people want,” she said.
She insisted that “All of the evidence we have now is suggesting that smoking not only harms people’s physical health but is detrimental to their mental health and wellbeing”. But when Vine confronted her, asking “What evidence?” she was unable to answer. Instead she generalised, repeating that there is “quite compelling evidence suggesting that quitting smoking enhances people’s health and wellbeing”, and underscoring the need for “cost effective treatment”.
In fact, Mr Day’s 33-page paper, which sets out the rationale for banning smoking in mental health units, cites just one research paper on the interaction between chemicals in cigarette smoke and medications, on which the claim that £40m could be saved presumably was based.
That paper, published in 2007, looked at the effects of smoking on medicating for a whole range of health issues, including asthma, heart failure or pneumonia. It cites another study which found that “if a patient is taking clozapine [an anti-psychotic drug] and starts smoking, the clozapine dosage may need to be increased by 1.5 within two to four weeks.” However, it also noted: “smoking does not affect the metabolism of quetiapine, a more widely used atypical antipsychotic.”
Not only does the evidence for the policy look thin at best, the policy may be illegal. Under the Mental Health Act, patients committed to a psychiatric unit cannot be treated for physical health problems, including tobacco addiction, against their will.
The mental health charity Rethink Mental Illness explains: “If you need urgent mental health treatment you can be taken to hospital and given treatment without your consent under the Mental Health Act 1983 (MHA). However, just because you are mentally ill it does not mean you lack capacity.
“You cannot be given treatment for a physical illness without your consent under the Mental Health Act 1983. If you have capacity to make a decision then you can refuse treatment for a physical illness even if you need it.”
Dr Jon Stanley, an emergency medicine practitioner with a decade’s experience in the NHS told Breitbart London: “To treat someone who has been sectioned for a physical illness without their consent could be considered assault. At the very least, it is certainly a slippery slope from treating someone for smoking addiction against their will to forcing any treatment upon them.”
His point was echoed by Simon Clark of the smokers’ rights group Forest, who told the BBC: “Public Health England has no right to deny people choice. Who are they to dictate whether or not a mental health patient can smoke a product that is legally available to every other adult in Britain?
“What PHE is proposing is discrimination. It will target unfairly a group of people who, being dependent on others, has little alternative other than to comply.”
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