Health zealots have taken over the asylum

Plans to ban smoking in a mental-health facility reek of illiberal cruelty.

Barry Curtis

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Topics Politics

In what must be considered a lunatic move, East Lancashire NHS Trust has banned smoking inside and outside all of its mental-health facilities. This includes the use of harmless e-cigarettes. Health zealots are presenting this as a compassionate gesture to improve the health of mental-health patients. In reality, it is insane. For the following reasons:

1) People who smoke will be deterred from checking in for ‘voluntary assessment’, even if they or their friends and family sense their mental health is deteriorating. For smokers, the act of smoking is an integral and essential pleasure, which seemingly prompts others to conclude that it must be addictive. The idea that you’d have to give up this pleasure as a trade for psychiatric care would seem unbearable for those on the cusp of becoming really ill. The smoking ban will cause the mental health of many potential patients to deteriorate further, with hellish consequences for themselves and wider society.

2) If you are a smoker who gets sectioned under the Mental Health Act, smoking is often the only thing that keeps you calm. Many of those who are sectioned will already be suicidal, so it is essential that official policy does everything it can to ease their strife. Being in a psychiatric clinic is a very stressful experience, and anything that can aid your recovery and truncate your length of stay should be welcomed. A smoking ban would be perceived by some unwell individuals as an act of tyranny. Many people who get sectioned will, quite naturally, look upon psychiatrists as authoritarian – and a smoking ban will intensify that perception. It will lead to increased distrust and conflict between patient and staff, at a time when staff already have an uphill struggle to convince patients they are on their side.

3) Psychiatric clinics should be about mental health; physical health is secondary. This is why there are generally no gymnasiums in mental-health clinics. Institutions prescribe drugs that have negative physical side-effects, such as Olanzapine, which causes phenomenal weight gain and lethargy; but it is right that they prescribe such drugs for cases of, for example, psychosis, because a mental-health institution’s main concern is mental wellbeing, not physical fitness. In this context, permitting smoking is important, since the prospect of an individual shaving five minutes off his or her life by having a cigarette is less important than getting him or her mentally well again.

4) The right of patients to smoke doesn’t have to apply to every room. In the interests of non-smoking mental patients, it is right that communal places in mental-health institutions, such as TV rooms and dining areas, do not allow smoking. Also, where there is a fire hazard, a ban should be enforced – this could even apply to private bedrooms, where a heavily sedated patient might fall asleep with a cigarette on the go. But there ought to be dedicated smoking rooms just for the smokers. The worries of non-smokers would be irrelevant since they wouldn’t have to go in these rooms. At the very, very least, smoking must be permitted in outside areas.

5) Since those sectioned cannot leave the premises, the psychiatric institution is their home for a period of time. To ban smoking in all rooms is therefore equivalent to a totalitarian state banning smoking in an individual’s own home. Restricting certain behaviours in public is one thing, but in your own living quarters? When the only person you are potentially harming is yourself? This is a vindictive and cruel act by East Lancashire NHS Trust – let’s hope it scraps its plans, and that other trusts do not attempt a similar act of authoritarianism.

Finally, as a confession, I was once a mental-health patient. I was studying for a PhD in philosophy at the time (2001) but got entangled in a logical rut where I was trying to combine Hegel’s idea that ‘the form of appearance is an aspect of the thing itself’ with a subjectivist view of what ‘the form of appearance’ meant. Consequently, I came to believe it was possible to change objects just by imagining them differently. Probably smoking weed at the time, like most philosophy students do, didn’t help. A mental breakdown ensued, and I was detained for five weeks. It was only when the doctors gained my trust and the anti-psychotics kicked in that I began to get better, and their permitting my smoking was an essential part of my recovery. I dread to think what could happen to mental-health patients in this day and age. Don’t worry, I’m better now, but I avoid Hegel like the plague.

Barry Curtis is a writer and researcher.

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