A cruel and unusual ban
The smoking ban in psychiatric institutions means their patients are the only people in Britain forbidden from smoking ‘in their own homes’.
This week in the UK, High Court judges ruled that psychiatric patients detained in high-security hospitals have no ‘right to smoke’ (1). The case was brought by three patients at Rampton Hospital, who argued that a ban on smoking was an attack on their human rights. They lost, and now the new ruling will cover Rampton and England’s two other high-security hospitals, Ashworth and Broadmoor. It is also likely to apply to the many other regional ‘secure units’ scattered around the country.
That even psychiatric patients, some of whom are locked up for years, will be denied the small pleasure of having a fag shows how petty and cruel the anti-smoking crusade can be.
The appeal by the three Rampton patients followed the introduction of the ban on smoking in ‘enclosed public spaces’, which came into force in England on 1 July 2007. That ban was an affront to freedom and choice, no doubt, but at least most smokers could continue to light up in the privacy of their home or by popping outside of an ‘enclosed public space’, whether it be on the street outside their workplace or outside a pub or restaurant.
Yet this is not so simple for many people whose home doubles up as a ‘public space’ – for example, people who live in residential homes or psychiatric institutions. Often they do not have the freedom to go outside for a cigarette, and because people work where they live – in their recreational areas, kitchens, bedrooms – they cannot smoke ‘at home’ either (2).
It was in recognition of these complexities that the New Labour government gave psychiatric institutions until July 2008 to come up with some form of secure outdoor smoking area for psychiatric patients. However, Rampton has already implemented a smoking ban, which means that patients can no longer smoke anywhere in the hospital. And it now looks like other institutions will follow suit.
Staff at Rampton, Broadmoor and Ashworth frequently stress that these places are hospitals, not prisons. This is rather unfortunate for the patients who live there and who enjoy smoking – where prisoners are still allowed to smoke in their cells, hospital patients are not allowed to smoke in their beds. This week’s High Court ruling means that psychiatric patients are virtually the only group of people in the country who are not allowed to smoke in the ‘privacy of their home’. As Neil Rafferty of the pro-smoking group Forest said: ‘I think it is cruel to impose what is a petty bureaucratic decision in this way. The hospital should be able to provide a facility for these people to have a cigarette.’ (3)
Detained patients have one other major disadvantage over ordinary prisoners – they do not have a release or discharge date. It is up to psychiatrists, tribunals or the Home Office to decide when they should be let out. Many who live in Britain’s Special Hospitals will never be discharged back into the community; others will remain within the confines of the hospital for several years, if not decades. As such, it seems reasonable to allow them to have a smoke – after all, it’s hardly going to ruin their lives.
Yet according to Lord Justice Pill in the High Court this week: ‘Both health and security considerations justify the ban.’ (4) In fact, neither of these considerations is as clear cut as the judge makes out. Of course, nobody doubts that smoking is bad for smokers’ physical health. But many of these patients are given, often against their will, high doses of psychiatric medication which can have severe side effects. Some of them may see smoking as relatively harmless in comparison to their drugs, and also as a pastime that alleviates boredom and encourages sociability. Meeting in a designated space to share a cigarette is a way of talking to and getting to know others.
It is true, of course, that many (though certainly not all) of the patients in Special Hospitals are extremely disturbed and dangerous individuals who will have committed serious offences, including manslaughter, rape, arson and assault. So the judge is right that security needs to be taken seriously in these establishments. However, the clue is in their names – they are High Security Hospitals or Regional Secure Units. Such places are surrounded by walls and the security within them is extremely tight. On the few occasions I visited Ashworth between 1995 and 2001, I was not allowed to go anywhere on my own, searches were common, and the security procedures were rigorous.
In short, security has always been a major issue in these hospitals. So to argue that the smoking ban is justified due to possible ‘security difficulties’ is absurd. Yes, there may be occasions when certain individuals or groups are not allowed to congregate together due to security concerns, but to replace day-to-day risk assessment by hospital staff with a total ban on smoking anywhere in psychiatric institutions suggests that the ban is being used to institutionalise risk aversion.
Many used to refer to the old lunatic asylums as ‘the bins’. Their rise was viewed by some, not as a consequence of medical advance, but as an institutional solution to social problems; they became places to dump those who were not wanted by the rest of society (the incarceration of unmarried mothers was the clearest example of this). Today, exaggerated claims from health campaigners on the dangers of passive smoking have been mixed with a broader risk-averse outlook, and once again it is to the detriment of those confined in long-stay mental institutions. At least the inmates of the old asylums could have a cigarette; now they cannot even enjoy that small mercy.
Ken McLaughlin is a senior lecturer in social work at Manchester Metropolitan University, England. His book Social Work, Politics and Society: From Radicalism to Orthodoxy is published on 1 July by Policy Press.
Ken McLaughlin described the smoking ban in psychiatric institutions as madness. spiked writers around the world reported on the global crusade against the ‘evil weed’. Nathalie Rothschild reported on a rare protest against the English smoking ban. Mick Hume reflected on what the ban says about today’s society. Or read more at spiked issues Smoking and
(1) Patients lose smoking ban appeal, BBC News, 20 May 2008
(2) See Lighten up, and let the patients light up, by Ken McLaughlin
(3) Patients lose smoking ban appeal, BBC News, 20 May 2008
(4) Patients lose smoking ban appeal, BBC News, 20 May 2008