Smoking ban in psychiatric services

O’Gara & McIvor (Psychiatric Bulletin, July 2006, 30, 241–242) raise concerns about the introduction of a smoke-free health service in England and Wales by December 2006. In March 2004, Ireland became the first country in the world to introduce a complete prohibition on smoking in the workplace to protect people from the harmful effects of second-hand smoke. Psychiatric hospitals, including the Central Mental Hospital and Prisons, were granted an exemption from the ban. However, it was decided by the management team at the Central Mental Hospital (Ireland’s only forensic psychiatric hospital) that the hospital would not avail of this exemption. Other psychiatric hospitals in Ireland did avail of the exemption.

Six months before the commencement of the ban, a smoke cessation counsellor was employed to organise individual and group work for staff and patients. Nicotine clinics and awareness groups were set up.

Upon commencement of the ban, patients who wished to smoke were taken to designated outdoor areas, five to six times during the day for an average of 20 min and for longer periods during the summer. They have no access to these facilities at night.

Initially, not everybody was supportive of the policy. Some patients wrote letters of protest demanding that smoking rooms be provided. Surprisingly, there were more complaints from staff than from patients. The rights of both smokers and non-smokers were highlighted. Resistance lessened within weeks of commencement of the ban.

Following the implementation of the ban, the wards became noticeably cleaner and smoke-filled air disappeared. Our experience at the Central Mental Hospital has demonstrated that it is feasible to implement a total smoking ban in a psychiatric hospital.