Smoking has no place in psychiatric hospitals

O’Gara & McIvor (Psychiatric Bulletin, July 2006, 30, 241-242) address the issue of smoke-free legislation and mental health units and endorse the view that smoking cessation should be encouraged in psychiatric hospital settings. The concern remains that some psychiatric units will be exempt from the smoking ban. This can only further alienate psychiatry from medicine and increase stigma against psychiatric patients and services. Admission of smokers with mental illness to smoke-free psychiatric units may lead to behavioural deterioration, but some evidence refutes this argument. The implementation of a smoking ban, establishing a smoke-free psychiatric service and abolishing tobacco products, created minor management difficulties on a locked psychiatric unit (Ryabik et al, 1994). The effects of prohibiting cigarette smoking on the behaviour of patients on a 25-bed psychiatric in-patient unit were assessed immediately after implementation of a smoking ban and 2 years later. No behavioural disruptions were observed after the ban, and discharges against medical advice did not increase immediately after the restriction on smoking or 2 years later (Velasco et al, 1996).

Signs and symptoms of nicotine withdrawal and alterations in psychopathology were evaluated among psychiatric patients with acute illness admitted to a hospital with a smoking ban (Smith et al, 1999). Despite patients’ reports of feeling distressed and of experiencing nicotine withdrawal symptoms, abrupt cessation of smoking did not affect psychopathological symptoms during admission (Smith et al, 1999).

The above evidence shows that smoking has no place in psychiatric hospitals, and that a smoking ban can only improve the well-being of patients, staff and visitors.