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Objection to the Smoking Ban in State Facilities |
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Letter from John Tote to the MHDDSA Commission regarding the Smoking
Ban in State Facilities.
March 14, 2008
This letter is intended to object to the Smoking Ban in State Facilities. The Mental Health Association in NC (MHA-NC) recognizes that cigarette smoking
and smokeless tobacco use creates significant health problems for people with mental illness/brain disorders, for those who provide services and supports, and for the general public. Research has
shown that people with mental illness/brain disorders are twice as likely to smoke as the general population and that people with schizophrenia are three to four times as likely to smoke as the
general population. The negative effects of cigarette smoking and smokeless tobacco use on personal health are well documented. The negative effects of second hand smoke for those who do not
smoke are also well documented. Thus, MHA-NC recognizes the importance of creating smoke free environments in state facilities, including psychiatric hospitals and treatment facilities. Many
studies have shown that banning smoking in psychiatric hospital settings has no major effects on behavioral indicators of unrest/aggression and compliance, but also show that these bars do not
produce long term smoking cessation for individuals with mental illness.
At the same time, MHA-NC recognizes that requiring consumers to stop
smoking when hospitalized can, in some individuals, exacerbate psychiatric symptoms. Research has suggested that smoking may reduce depression, anxiety, and negative symptoms of schizophrenia, as
well as relieve the Parkinsonian symptoms associated with antipsychotic medications. We recognize that other therapies may not have met these needs for individuals, and that
smoking, while not a desirable method to alleviate symptoms, is utilized as such. In addition, nicotine has been shown to decrease the blood levels of antipsychotic medications, therefore causing
smokers to require higher doses for anti-psychotic medications than non-smokers and medication adjustments in those who have abruptly ceased smoking.
Additionally, this rule is being unequally applied, as it is only patients
who are affected, not staff. The law simply removes the right to smoke within the facility; it does not require a smoking ban outside of the facility, as such the grounds are open for smoking
access. This allows for further inequities as well. Some facilities may allow their patients to smoke outside; but what of those who cannot get outside
easily as a result of their disability? Will they be forced to remain inside during a “smoke break” when others who are more mobile are able to walk outside?
To compound MHA-NC’s concerns, it has been determined that there is no
need for a fiscal note thus leaving vulnerable consumers at the mercy of a facility to decide if it will provide smoking cessation supports or allow smoking outside. If a
facility decides not to provide the necessary supports, then an individual who is already under duress and experiencing acute stress will have to also endure the pain of nicotine
withdrawal. Nicotine withdrawal is difficult for people to manage. Forced withdrawal without supports could be considered
inhumane.
Based on this, MHA-NC recommends
the following course of action for the State of North Carolina in implementing its ban of smoking in state facilities as based on advocates’ policies and researchers’
suggestions:
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Replacement therapies, counseling and smoking cessation support should be available to individuals who require a stay in the
state hospital as well as those who reside in the community. “Emergency Relief” packets provided for hospital visitors (similar to UNC hospitals), upon request,
should be available and well advertised.
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Screen individuals for tobacco dependence and, if it exists, include that in their diagnosis and in the treatment plan in order
to start the process of a true person centered plan to
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include achieving the best possible health. Short, validated, easily available screening tools already
exist.
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Incorporate tobacco dependence education interventions and treatments into the person centered plan based on the
individual’s choice to do so. Provide support for those who wish to quit and facilitate choice amongst options.
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Review individual’s medical status for medication interactions and adverse effects from cessation of smoking, including
increased concentrations of psychiatric medication.
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The ban should be consistently implemented across the state, including training staff in understanding nicotine dependence, etc.
Allow enough time to prepare staff and educate the public.
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The ban and available interventions should be well publicized and communicated to patients, staff, and visitors, as well as
community mental health agencies. Work in cooperation with those community agencies to spread word of the ban and interventions available.
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Set clear policies using clinical and ethical guidelines. Be aware of potential underground use and sale within facilities and
respond in a reasonable way that ensures individuals get the services and supports they need.
While the negatives of smoking are known, MHA-NC hopes that the Commission considers our concerns
and strives to implement these policies within the rule change.
We appreciate your time and consideration on this very important
issue.
Sincerely,
John Tote, III
Executive Director, Mental Health Association in NC
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