Allowing smoking (a pathological coping mechanism) in a psychiatric setting is detrimental to all involved. If as you claim (yet a few moments on google scholar disputes) smoking tobacco reduces symptoms of akathesia. Then surely a healthier approach would be to provide nicotine replacement therapy. This would provide the benefits you claim from smoking whilst removing the risk of well known detrimental effects caused by smoking.

Having worked as a mental health nurse for several years, it has been my experience that smoking and the provision of cigarettes has been the instigating factor of several violent conflicts.

We should not be allowing or encouraging people to utilise pathological coping mechanism when they are facing a crisis. When alcoholics and heroin addicts are admitted we provide healthier alternative and encourage them to reduce their dependence.

Smoking causes harm not just to those choosing to smoke but also to all those around them including the poor nursing staff that are forced to be present while patients smoke due to duty of care.

I have seen the tragic effects of young people on their first admission who previously have not smoked. Taking up the habit and plunging into a life time of addiction to tobacco and the health risks it presents.

Admission to acute psychiatric settings is on average around 10 to 12 days. When you consider how a tiny number of long term patients skews the average. Most admissions are much shorter.

Admission to an acute psychiatric setting is universally because the person has become a danger to themselves or to others. Surely the health system cannot then condone smoking (a danger to the person and others).

People should be encouraged to develop healthy coping mechanisms that will not be detrimental to them physically, mentally and financially.

Please remember one of the universal principals of any health professional is Primum non nocere. First do no harm

Knowing what we know about the health hazards of cigarette smoking and passive smoking, it would be very hard to think of an argument against Smoke Free hospitals. However, the issue of not just making psychiatric wards a part of the Smoke-Free policy but of making it impossible for a psychiatric patient to make their own informed decision about smoking or quitting takes the argument to a whole new dimension.

I see psychiatric patients as people who are not only in great mental and emotional crisis and distress but as people who have had their basic rights and freedoms taken from them because they have been deemed to be a 'danger to themselves or others'. An involuntary hospitalisation renders them powerless - disempowered to a degree matched only by those who have been incarcerated for serious crime.

Is it really the hospital's role or right to make it impossible for patients to choose by not only enforcing the smoking ban on the ward but also removing access to areas where they are free to smoke?

If the hospital's intention were really about health, then patients would be counselled, educated, offered nicotine replacement - all of which the patient would be free to accept or decline throughout their stay AND this support would follow the patient after their discharge.

Whilst in an environment where they are unable to exercise their right to choose and whilst upholding the rights of others to a smoke-free environment, is it beyond the imagination of hospitals to provide a well ventilated, secure smoking area outside the bounds of the ward?

Rebekah, I found your description of 'akathisia' disturbing, and your 'lived experience' of the effects of smoking on relieving some of the distressing symptoms most interesting.

Gadphil, is your statement about "young people on their first admission who previously have not smoked" being plunged "into a life time of addiction to tobacco" supported by evidence? Rebekah's experience tells us once she was well and no longer taking dopamine depleting medications, she no longer had the desire or compulsion to smoke. This is worthy of further investigation.

Having also worked on psychiatric wards in the past, I am totally in support of a ban on cigarette smoking among inpatients, as long as nicotine replacement therapy is commenced at the same time.

Talking about the 'rights' of mental health patients is a minefield really. If we don't forcefully detain people for their own safety, then we are vilified for letting them go on their way and then harming or killing themselves!

The seriously ill mental health patient is often prescribed very heavily sedating medications to get them through the dangerous acute part of this illness episode.
How does anyone imagine they can then be allowed to continue smoking safely in that state?
They have and will continue to burn themselves alive in their beds or other ward areas, and put all other staff and patients at risk as well.

There is no way that many mental health inpatients can be 'left alone' to smoke in designated smoking areas, without the need for staff to access them for treatment.
Should these non-smoking staff members be subjected to inhaling smoke in these areas of their workplace?

Why is it more acceptable for staff in these wards to be subject to passive smoking than in any other workplace in Australia?

Mental health staff already suffer enough verbal and physical abuse to allow smoking to go on in those wards anymore.

A very good subject, Government should either S...T or get off the pot when it comes to restrictions on smoking. At this point in time smoking is legal, it is also an addiction, I am probably behind in the thinking of government(s), but when we have drug addicts having access to the methadone treatment (free, last time I looked), why should smokers, who are genuinely trying to kick their addiction, pay huge amounts of money for nicotine patches, having said that, I acknowledge that perhaps the cost of nicarettes has decreased. So is the Government of the day, (continuing on from former Government,) hanging on the fringe of banning cigarettes or is the profit from selling them too much to forfeit?.
I haven't worked in the psychiatric world, but have seen the results of life long smoking when I worked in an aged care facility.....it aint pretty!.
NSB

Thank you Rebekah, your personal experience adds much to this copmplicated question. My daughter had once given up smoking but began to smoke again as schizophrenia changed her life for ever and eventually led to her death by suicide.
I'd not heard of'akathisia' before this, but I feel it was what Anne suffered from when she'd say about her smoking, "It helps the pain in my head, mum". I never tried to stop her. In the 24 hours before her death we found she had been smoking continuously. I hope it helped her in some way.
I read your previous article, not seen before. You are a brave, resourceful woman and your story is important, thanks.

Indeed, let there be no doubt, "Akathisia" is extremely debilitating.

..

But not just triggered by say D2 Antagonists, but also by 5HT2A antagonists, as evidenced by treatment programs incorporating the drug "Abilify."

(a matter most interesting)

..

Insight , advanced recovery and a high level of functioning notwithstanding, I am not free of my need for the occasional post synaptic dose of AmiSulpride (400mg) and also the occasional dose of Abilify (10mg.)

(To put this in context, "normal" life becomes a balance in between the twixt poles of symptoms and side effects.)

However, at these doses for me, *Akathisia* which I loathe far more than hallucinations, can be induced.

(It is a matter which is subjected to an ongoing process of monitoring and review.)

..

Ultimately, in this area of neurochemistry, I concurre with the writer that it is a question of balance, and that neuroleptic medication can quickly become too much of a good thing.

However, I do not support her conclusions (and I would draw strength from both sides of the arguments presented so far) except to the extent that i.m.o. it would be better for the hospitals to have a nicottine and or CBD spray/replacement therapy in advance to eliminate smoking induced complications (I gave up smoking cigarettes more than 10 years ago)prior to instituting sudden change and risking a backlash.

(For the nurses I believe also something like additional security to bolster and enhance safety in their working environment would be appropriate in advance as well.)
..

As with most things of a psychiatric therapeutic nature, gentle subtle changes are the way to go.

Thus, in the above cited example, I break my dose in half, take it with half a analgesic/calmative to reduce uptake pain, and then leave it for a good hour or more before I have the second half.

Done in the morning, this mitigates the rise of *Akathisia* and makes for a productive day and deep dark sleep at night post healthy exhaustion.

Am inclined to mostly agree with Dooey. Though not everyone admitted to an acute facility is there under involuntary order, those who are suffer deprivation similar to high security prisoners. Most will be well established smokers and many will have alcohol or other substance 'issues' as well.

Once in the Unit, the only likely 'comfort' is going to be the old cancer sticks. Any other 'crutch' the patient has been using will be withdrawn - completely and abruptly. A non-smoker who'd rather everyone else was too, I still support the availability of a smoking area for these people even if nicotine replacement/Quit therapy is at hand. BTW - is it usually available and offered?

Provided there is a secure outdoor area designated for smokers I can't see a great problem for staff either. Sure it's a bit of a pain policing the "No Smoking except for designated area" rule and patients cadging or squabbling over cigarettes can create some hassles but the suggestion that Duty of Care requires staff to be at the patients side while he/she has a smoke is false. They just need to be able to observe from a reasonable distance.

Smoking is highly undesirable, but here I feel it is a lack of compassion that may be the greater of two evils.

I am very sorry to hear for the pain of your loss *Carol83*

..

There were some who feared that they would lose me some 15 years or so ago.

..

Had I known then what I know now about the condition, I could have initiated a powerful mechanism for likely recovery in no more than 3 months, but as it was, it took me the best part of 10 years to bring it all together and to come back from once being a *Clozapine* patient to where I am now here to converse with you.

..

I recommend the following for everyone's interest and note that there is no risk of *Akathisia* associated, not to mention the cost savings to the PBS and likely increased longevity to those inflicted, who otherwise depend on neuroleptics which have been evidenced by the morgue to take 10 - 15 years of the lives of sufferers:

http://en.wikipedia.org/wiki/Cannabidiol

This was a good article and a subject that has caused me a great deal of harm as a mental health nurse. This ban on smoking "on all hospital grounds" has been in place in WA for some 3 years. It has been disastrous.
The distress caused to involuntary patients admitted to locked wards and denied the ability to smoke is terrible to see. The policy is nothing short of cruel. People in the throws of a psychotic episode are seldom able to be reasoned with and tend to [perceive the ban as a malicious act of the nursing staff. This causes a massive amount of conflict in an area that is already fraught with conflict. Far from reducing the dangers to nursing staff (from outdoor environmental tobacco smoke, a very minor danger) it has increased the danger of assault and massively increased the amount of abuse thrown at us by distressed patients.
There is a very close association between tobacco use and schizophrenia. People who go on to develop schizophrenia smoke at much higher rates even before the onset of their illness. Furthermore the medications they need to take increase their desire to smoke. This has been shown in double blind trial.
Its all very well offering nicotine patches or gum, but these simply don't cut it. They want a smoke, not a patch.
No other group in our society is being singled out to be forced to give up smoking. Even prisoners are still allowed to smoke.
It is not surprising as the mentally ill are probably the most voiceless group in society and so vulnerable to those who wish to force their ideology onto them.

In addition the bans have not achieved what they set out to achieve.
As there are no longer discrete smoking areas in the hospital, voluntary patients or those with leave from the wards (as well as staff) smoke on the pavement outside the hospital, which not only looks bad, but forces anyone who wishes to enter the hospital to walk through a haze of smoke and wade through cigarette butts. Now patients smuggle lighters in and smoke in their rooms where there is a genuine fire risk, rather than in outdoor smoking areas where a safe lighter was provided.
This policy is simply using the mental health act as a tool to force people to give up smoking. The mental health act was never meant to be used for this purpose. In fact the Western Australian Mental Health Act states in section 5 that its objective is to ensure that the mentally ill receive treatment with "the least restriction on their rights, dignity and freedoms". Forcing someone to give up smoking at the worst possible time in their lives is hardly the least restriction on their rights or freedoms.

Yes but *Rhys* whilst there is merit in what you say, overcoming the "addictive mind set" for want of a better term, and side effects of substances such as niccotine, is also one of the goals on the road to ever greater recovery.

Additionally, there are alternatives to generating a bi-release of dopamine to rebalance the system post antagonist over dose, such as the partial dopamine agonist properties of the drug Abilify to be consumed first, prior to pushing the antagonists higher up and closer to the trouble, which is a possible better targeting strategy.

..

I enclose a glad bag of good things for cognition and mental health, compiled from a variety of sources such as "New Scientist" for everyones interest:

a. Clean water, a healthy diet (heavy on the veg) + omega 3 + active daily exercise.

b. Flavenoids (Blueberries, Red Wine(hmmm), Dark Chocolate (Hmmm), Magnesium-L-Threonate)

c. Bright (blue) light (protect the eyes though)

d. Meditation pre-activity

e. Music training

DreamOn, Whilst giving up nicotine addiction may be one of your goals, it is not necessarily the goal of all people suffering a serious mental illness. And while it may be the goal of many, few would feel that the middle of a psychotic relapse, accompanied by forced hospitalisation, and the accompanying psychological distress, is the appropriate occasion to bring this goal to fruition.
I am fully aware of the terrible effects of tobacco on the physical health on the mentally ill, just as I am aware of the terrible effects of tobacco on the health of the non-mentally ill. I simply feel we should treat the mentally ill with the same respect we afford all other Australians. Not singling them out for this peculiar punishment.

It seems that you have not read all of the preceding posts *Rhys* or you would be aware that I gave up smoking cigarettes more than 10 years ago. Also, I have not consulted with anyone who actually knows what they are talking about who considers that my mental health has declined as a result of stopping smoking cigarettes. Further, and again had you actually read everyone's post, you would be aware of the reality of their views, assuming you actually comprehend that is, as clearly you are incorrectly aware of mine?

..

If you feel so strongly about it, why not get a new job?

DreamOn,

I did read all the posts. Whether or not you gave up smoking ten years ago is irrelevant. This issue is whether people other than yourself should be forced to do so at the worst possible time of your life.
I to gave up smoking a number of years ago and am truly glad I did. The difference is I did so at a time of my own chosing.
While I could get a new job, that will not prevent the most vulnerable in our society from suffering unnecessarily as a result of this policy.
Please do not take offence at my posts. I meant no disrespect to yourself. I merely disagree with your position on this matter, just as you disagree with mine.

Nicotine replacement is not an alternative to smoking, it’s an aid to give up smoking. Who are you to dictate to someone they must need to wean from their legalised habit of smoking?

This article has helped me understand a lot. I have witnessed someone have a ‘break down’, and during that time she went from someone who despised smoking to someone who would get out of bed at 5 am to feed her need to smoke.

Nicotine patches cannot do what smoking does. When someone has an urge to smoke, they can choose just how much they want, when they want it. The person I know would have bouts of smoking every 15 to 20 minutes. What nicotine patch could keep up with that?

There’s not only this horrible akathisia, what about the psychological aspects of smoking? So you give them a patch and think it’s quite all right to make them go cold turkey on their psychological needs. And at a time when their stress levels must be through the roof. Just sounds cruel to me.

Nicotine patches just cannot replace all that smoking fulfils for the smoker.

Perhaps I could expand on that smoker/pregnancy craving analogy:

What if a pregnant woman with a killer craving for pickles was told she couldn’t have any whole ones but that there were some alternatives. She could instead slowly sip all day on pickle juice. Or perhaps some pickle puree could be offered, a teaspoon or so to be taken each half hour throughout the day. Do you think she’d be just as satisfied with these options? Somehow I really doubt it.

I agree completely Rhys. In fact, I'm quite sure that the prohibition on smoking in ordinary hospitals, is detrimental to the recovery of many patients.

A neighbour of mine, a single pensioner, was over 70, about 6 years ago, when he had a reasonably minor heart attack.

Having been stabilized, [his clot dissolved], at the local hospital he was transferred to a large city hospital. After 60 hours, when he had not been examined by a cardiologist, but had not been permitted to have a cigarette, he checked himself out. As he had no money, someone rang me for him, & I went & picked him up.

It is a good thing I picked him up in a convertible, with the top down, he chain smoked for the hour & a half it took to get him home. He emptied a packet. I doubt that sort of desperation is really much good for anyone.

As He said, he is over 70, stopping smoking is not of great importance. The hospital was built with outdoor smoking areas, so why all the bull dust.

He had upset them by not being a sheep. They took 3 months to get round to testing him. He had a stent fitted, but was not going in if he had to stay longer than overnight.

He's still going strong, smoking like a chimney, & will probably outlive me, despite all my purity, & healthy living.

Smoking causes harm not just to those choosing to smoke but also to all those around them.
Gadphli,
why stop at smokers ? Motor sport indeed many other sports are super charged when it comes to emission. Just look at the last Tour de France. All the cars, the media & spectators flying in from all over etc. Just the other day I was listening to some young people raving on about climate change due to industry then, only a moment later they started on where they were going to travel to. All over the world. So, a little smoke here'n there ? I'm a former smoker & I gave up because it started to slow me down. Howver, meanwhile I found that government policies are slowing me down way more. If we're so concerned about emission & smoking is an emission then let's be serious about it.
Smoking is a silly habit with serious side effects but so is mass spectator sport.

I guess it is time to jump back in to the fray.

Dooey,

My statement is based on several years experience working in different psychiatric settings and the well known fact that smoking tobacco is one of the most difficult addictions to deal with. Nicotine is known to be one of the most addictive substances known to man. Yet it is in the ingestion of the smoke that most of the health risks stem. I have not searched for any longitudinal studies on the issue but agree further investigation would be worthy and am confident it would support my argument that smoking is prevalent across the lifetime of sufferers of mental illness.

Individual,

You questioned me “why stop at smokers?” and then attempted to link it in a most bizarre fashion with motor sports, the tour de France, cars, media, climate change discussions in the media and young people travelling around the world. I fail to see even the most tenuous link these have with the subject we are discussing. But I will try and answer your question for a bit of fun.

Ok here goes. I wouldn’t stop at smokers, If someone is in a mental health facility because they have become a danger to themselves or others, I would also be comfortable with stopping them from engaging in motor sports, the tour de france, cars, media, climate change discussions in the media and young people travelling around the world. At least until they have been seen to no longer be a danger to themselves or others.

As an aside. I have no problem with smoking when it does not effect other people. As in the privacy of your own home or a reasonable distance from other members of the public. But why should the tiny outdoor areas that are provided for people in some mental health facilities be filled with the lingering stench of tobacco smoke, rather than fresh air.

Primum non nocere. First do no harm

addition

On another more relevant subject.

I don't buy the argument that because people are going through a crisis or are bored, that it should be condoned that they be able to smoke and utilise pathological coping mechanisms. It is well known that addictive behaviour of all kinds usually can’t change until the addicted person reaches the metaphorical "rock bottom" and see in them selves the need to change.

In my years of working in different mental health settings I have seen cigarettes become such a prized commodity that vulnerable people have done distressing things to gain the favour of people with the cigarettes. This has included but has not been limited to threats of violence, extortion and prostitution.

Mental health facilities should be a asylums (a place of sanctuary) that provide a safe place in which people can develop a healthy response to the trial tribulations of their lives

Well now Gadphli I can see the probable reason that mental institutions are so notoriously incompetent at the job they are supposed to do.

It would appear they are staffed by little dictators, who have a know all attitude, & are not interested in listening to anyone who might have a suggestion.

Considering the high failure rate in the treatment of mental patients, a change of attitude would be in order. Something a little less smug & self satisfied would be more useful I would think.

I am in 100% agreement with Rebekah Bedoe's arttcle on smoking for psychiatric patients. To force smokers to give up their best anti-anxiety tool is (pardon me) insane in a mental health treatment setting. I say this as a three-time resident of a mental hospital. Without outside privileges (for example, after an involuntary admittance) a patient is not allowed outside to smoke at all. I agree with Rebekah that this is an unnecessary hardship at such a time - the time to quit is when the moods are stable and the psychoses are under control. And if nurses find there is violence over cigarettes, I suggest they abandon their monomaniacal obsession with "control" and start treating patients with respect for their own individuality - that would solve a multiplicity of trouble for everyone!

Wow Hasbeen,

How have you managed to get that many logical fallacy's into one post?

1. An Ad hominem agument and a non sequitur
"Well now Gadphli I can see the probable reason that mental institutions are so notoriously incompetent at the job they are supposed to do."

2. An Association fallacy and more specifically Godwin's law (http://en.wikipedia.org/wiki/Godwin%27s_law)

"It would appear they are staffed by little dictators, who have a know all attitude, & are not interested in listening to anyone who might have a suggestion."

3. Combination of a Non-Sequitur, Post-hoc ergo propter hoc and an Ad hominem attack.

"Considering the high failure rate in the treatment of mental patients, a change of attitude would be in order. Something a little less smug & self satisfied would be more useful I would think."

I think this debate/ argument would be best served within the realms of logic. I am always happy to listen and evaluate suggestions people might have.

I will employ my best logic and reason to evaluate the claims and then dispute or endorse those claims with a logical and reasonable response.

All I ask is the same. Attack my argument all you like with logic and reason. But please refrain from personal attacks and logically fallacious arguments.
Primum non nocere. First do no harm

Paul_H

You stated that "To force smokers to give up their best anti-anxiety tool is (pardon me) insane in a mental health treatment setting."

Tell us where it has been shown that cancer sticks are the "best anti-anxiety tool". If this were in fact true then wouldn't cigarettes be one of the most widely prescribed anxiety tools.

You also stated "And if nurses find there is violence over cigarettes, I suggest they abandon their monomaniacal obsession with "control" and start treating patients with respect for their own individuality."

To this I would like to put forward the following hypothetical for you to consider.
It is 2:30 am on a stormy night and a seventeen year old girl is admitted to the locked unit of a mental health facility. She has attempted suicide by slicing the inside lengths of her forearms and has been placed on the highest level of observation (arms length).
She is demanding a cigarette and the only person in the unit with cigarettes is a 35 year old Man with a primary diagnosis of bipolar disorder and an axis two diagnosis of anti social personality disorder.
As the nurse in this hypothetical situation what do you do?
How do you weigh up the following ?
The health of the non-smoking nurse who must remain at arm’s length from the girl at all times.
The girl’s individuality
The risk of fostering a dependent relationship on the man.
All in the pouring rain at 2:30 in the morning.
“PTLF”

link it in a most bizarre fashion with motor sports,
Gadphil,
apologies for that. I got interrupted & then utterly side-tracked & thought it was about emission etc. my bad.

Well your post said it all for me Gadphil. The arrogance flows from your keyboard like a river.

I rest my case.

I have met a mental health Doctor who was as irrational as a cut snake & more danger to his patients than a help & also I'm acquainted with two male mental health nurses who appear to aspire to the Doctors level of competence.
From what I have witnessed mental health is a far bigger problem from those who think they're doing something about it than those who suffer from it.

Antismoking has again been manufactured into a societal “ideal” by physicians playing social engineers, i.e., eugenics, and has been taken up by government health bureaucracies. They have learned nothing from their destructive eugenics quests of early-1900s USA and Nazi Germany. When health is erroneously reduced to only a biological phenomenon, an assault on other dimensions (psychological, relational) of health will occur. One would think that alarm bells would be ringing with this antismoking circumstance in, particularly, mental facilities given the long history of abuse of mental patients by officialdom. Alarm bells may be ringing, but there seem to be few that can hear them. As soon as medical administrators embark on “ideological” quests such as antismoking, only catastrophe can ensue. These antismoking measures are coercion to conformity. All must be made to bend to the medical will.

And it is not just patients in mental facilities. Over the last three decades, smoking/smokers have been denormalized/stigmatized; they have been slandered to high heaven. Smoking has been banned indoors. There is now an attempt to ban smoking outdoors. Those who smoke have been denied employment, access to medical treatment, and access to housing. Antismoking has deteriorated into a bigotry frenzy or a bigotry bandwagon effect – as it has in the past. In that this insanity has been “legitimized” by the medical establishment, all detrimental consequences are iatrogenic.

Antismoking is not new. It has a long, sordid – even murderous (e.g., King Murad) – history, where much of it pre-dates even the pretense of a scientific basis or the concocted idea of secondhand smoke “danger”.

There were concurrent anti-tobacco and anti-alcohol “crusades” in early-1900s USA. These crusades led to a temporary ban on the sale of tobacco in some states and smoking restrictions in most states, and eventually Prohibition immediately following WWI.
http://www.americanheritage.com/articles/magazine/ah/1981/2/1981_2_94_print.shtml

Pushed by the Eugenics and Temperance Movements, antismoking (and anti-alcohol) was viewed as in the interests of a “healthier” society. Rather, this fake “purity” promoted irrational fear, hatred, and social division: It brought out the worst in the human disposition. Baseless, inflammatory claims were made as a matter of course by so-called “authorities” and “experts”.

Anti-tobacco/alcohol reared their heads in pre-Nazi and Nazi Germany, again as a point of the eugenics framework.
http://www.bmj.com/archive/7070nd2.htm

It is important to note that the Nazis didn’t invent eugenics. It was popularized in America. German eugenicists (and Hitler) were students of American eugenics.

The contemporary antismoking “crusade” has been produced by the same eugenics personnel – physicians, biologists, zoologists, pharmacologists, statisticians, behaviorists – continuing the eugenics obsession with anti-tobacco. Health reduced to only biology is the eugenics framework and the aggressive peddling of the definition with a view to societal change (social engineering) is very much the fascism/statism of the eugenics mentality. It is the eugenics mentality that dominates health bureaucracies that has made antismoking a societal ideal.

The current antismoking crusade was put into motion in the mid-1970s under the auspices of the UN agency, the World Health Organization (see Godber/WHO Blueprint www.rampant-antismoking.com ). Rather than ban the sale of tobacco, the goal this time has been to ban smoking in essentially all the places where people would typically smoke. Indoor and outdoor bans were planned years before even the first study on secondhand smoke.

Some more on antismoking propaganda.

The official line is that there are no benefits in smoking which is only an addiction. This is an erroneous view that was peddled by the Temperance Movement in the 1800s and that was also picked up by the Eugenics Movement of early last century. Given the unfounded belief that there are no benefits in smoking, the question then becomes why people then continue to smoke. The eugenicists (physicalists) “resolve” this question by claiming that the entire behavior is held together by “nicotine addiction”.

Post WWII, nicotine was not considered an addiction. Nicotine was re-defined, contrary to available evidence, as “addictive” by US Surgeon-General C. Everett Koop in 1988 and very much in line with the eugenics view. The Office of the Surgeon-General had long been aligned to antismoking and a “smokefree” society.

It was also defined so in 1994 by an “expert panel” very much aligned to antismoking.
http://www.newscientist.com/article/mg14319381.300-us-ruling-turns-smokers-into-junkies.html

Some of the benefits of smoking:
http://www.ncbi.nlm.nih.gov/pubmed/20414766
http://dengulenegl.dk/English/Nicotine.html
Just nicotine is a cognitive enhancer. It aids focus. It is not surprising that some of the more profound intellectuals, writers and artists of the last century were smokers.

The latest that smoking is a habit, not an addiction:
http://www.sciencedaily.com/releases/2010/07/100713144920.htm

Nicotine is not peculiar to tobacco. There are small quantities in potatoes, tomatoes, green peppers, egg plant, and black tea.:
http://content.nejm.org/cgi/content/extract/329/6/437

Nicotine is also a precursor of nicotinic acid, also known as niacin or vitamin B3 (NIcotinic ACid vitamIN).

Smoking has numerous aspects – psychological, pharmacological, perceptual, behavioral, social. People smoke for different reasons at different times. Nicotine – just one aspect of smoking – is mild in effect, on a par with caffeine.

There are two main, interconnected reasons for the “nicotine addiction” myth. Firstly, it serves the deranged antismoking goal of a smokefree world legitimized by a eugenics framework. Smoking is depicted as useless, maintained only by nicotine addiction and where “addiction” is intended in the most derogatory sense of the term. This fosters the idea that smokers are reckless, “intoxicated”, irrational, irresponsible persons. And it is intended to create outrage in particularly nonsmokers. Nonsmokers who allow themselves to be brainwashed by the propaganda then demand protection from irresponsible “addicts”. Even more perverse is the claim that nicotine is “more addictive” than heroin or cocaine. Such irresponsible, agenda-driven statements trivialize what are profound differences between these substances.

Secondly, the nicotine addiction myth also serves the pharmaceutical cartel. By depicting smoking as due only to nicotine addiction, the pharmaceutical cartel has been able to peddle its nicotine replacement therapy (NRT) as the major/only means of quitting smoking. It was fully expected, according to the nicotine addiction model, that people would simply put on a nicotine patch and they would quit smoking. But it doesn’t quite work that way.

Yet, the success rate of NRT at one year is 3+% above a 3+% placebo baseline. At one year, NRT has a failure rate of ~97%. At two years, it is even closer to a 100% failure rate. This further and greatly undermines the “nicotine addiction” model.
http://www.bmj.com/cgi/content/extract/338/apr29_1/b1730?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=smoking&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT

The pharmaceutical cartel pushes for smoking bans and increased taxes on tobacco by funding antismoking groups. The medical establishment also peddles these essentially useless products. When bans and increased taxes are instituted there is an increase in NRT sales.
http://news.scotsman.com/tobacco/Nicotine-patch-sales-rocket-in.2766561.jp
http://www.independent.co.uk/life-style/health-and-families/health-news/bonanza-for-nicotine-gum-and-patches-as-millions-try-to-quit-456426.html
http://www.brudirect.com/index.php/2010120134492/Local-News/nrt-products-in-demand-since-cigarette-price-hike-says-jpmc.html

Knowing that these products are essentially useless, BP has even managed to weasel these products onto taxpayer-funded Pharmaceutical Benefits Schemes, e.g., Australia, Canada, where they are handed out like candy, making even more profits for BP. Worse still, BP has also been allowed to peddle the dangerous drug Champix/Chantix.
http://blog.al.com/spotnews/2011/01/birmingham_court_to_oversee_pf.html
http://www.lawyersandsettlements.com/articles/chantix/chantix-suicide-side-effects-57-15821.html
http://www.bnet.com/blog/drug-business/reports-of-psychotic-violence-on-anti-smoking-drug-chantix-pile-up-but-pfizer-isn-8217t-seeing-them/5163

While it is aware of these serious problems, BP is peddling this drug in Japan.
http://www.nytimes.com/2011/01/04/business/global/04smoke.html?_r=1&src=busl

Hasbeen
On what case do you rest?

You have not made one relevant or cogent statement regarding the subject. "Smoking bans: A threat to mental health".

All you have done is troll the forum providing us with irrelevant anecdotes, logical fallacies and personal attacks.

To rest a case you must first make a case.

Instead of attacking my argument you have decided to attack me personally. I am not the issue and insults are the ammunition of those to unintelligent to make an argument for their case.

In regards to your Ad hominem attack in which you claim that arrogance flows from my key board.
It’s only arrogance if you are wrong.

Maybe you need some time to go away and think a bit more deeply on the issue.

I challenge you to engage in a logical and rational debate on the issue or stop trolling and take your bat and ball and go home.

Individual.
In regards to your second last post. I can understand how that can happen. No harm done.
In regards to your last post all I can say is “one swallow does not a summer make”
There are good and bad people in all professions. Being a Doctor will never make one infallible. Highly educated and intelligent people are often shown to be experts in rationalising bad ideas.

James08

That was such a Gish gallop

The Gish Gallop is an informal name for a debating technique that involves drowning the opponent in such a torrent of half-truths, lies, and straw-man arguments that the opponent cannot possibly answer every falsehood that has been raised. Usually this results in many involuntary twitches in frustration as the opponent struggles just to decide where to start. It is named after creationism activist and professional debater Duane Gish.

http://rationalwiki.org/wiki/Gish_Gallo

How about someone provide try to privide a solution to my hypothetical? As this is the type of reality that health professional have to deal with on a daily basis.
It is a cheap shot to say that the people working in the system are little dictators obsessed with control.
When I think you will actually find that most health professional try to take a utilitarian approach.

*Rhys* had you both read and understood what I have previously stated you would realise that I had not advocated for denying *In Patients* a smoke.

(and I would refer you to my previous posts.)

However, as the thread is at risk of derailing into an over focus on the issue of cigarettes more generally, ..

*GadPhli*

I would think that if an individual is considered to be at risk of either harming themselves or others, then not only will they be deprived of their personal liberty, but they will also be forbidden from having access to anything that they may be able to do further harm with, such as a cigarette.

In the case of that state of consciousness that we refer to as psychois, as well as other extreme states, the medics can never be entirely sure thhat an individual in such a state is not capable of doing harm, to the extent that for better or worse, for right or for wrong, most individuals concerned are at tleast temporarily deprived of their rights in toto, which includes, alas for some, smoking ciggi's.

Further, *In Patients* are likely to be "limit tested" upon first arrival, and if they give trouble, strapped down in with a chemical straight jacket (something like AcuPhase) at which point it they will be largely disinterested in most things for a while, and would be an ideal time to slap on a patch or two, and when they are ready after some days for the antidote, and when they have otherwise earned the privilege, then they may again have a "cancer death stick" at that time. However, most certainly not before ...

(which will probably make them o.d. on nicotine and begin the process of negative reinforcement. With the later addition of gum (and some people stay on the nicotine gum for ever) the individual concerned will be on the way to a healthy withdrawal.)

Gadphli,
I think all that Hasbeen is trying to point out is the arrogance of presuming that you have the right to deprive another person of their rights on the basis that they are mentally ill (remember that the mentally ill are the only people in the entire country being forced to stop smoking).
I cannot understand how people who purport to have worked in this area, believe that it is just fine to increase the suffering experienced by these people.
As a Mental Health Nurse, I believe that a primary part of my role is to decrease suffering and provide comfort. This policy forces me to do the opposite.
Unfortunately, we inevitably have to provide some restrictions on people just to keep them safe. However, the only restrictions that should be applied are those that are clinically necessary. Any extra infringement of their liberty is unjustified. There is seldom a clinical necessity to prevent someone smoking (perhaps if they were actively burning themselves with the cigarette something I have only rarely encountered over the past twenty years). In fact, the physiological effects of nicotine withdrawal include anxiety, depression, agitation, and insomnia. These are all things we would ordinarily like to limit rather than intentionally induce.
Someone mentioned the phrase "first do no harm". That is exactly right.
Forcing a person to stop smoking at this time only increases their suffering and so causes them harm.

Gadphli wrote: I have no problem with smoking when it does not effect other people. As in the privacy of your own home

If an individual is taken forcibly from the privacy of their own home and relocated to a facility that must now become their 'home', must their right & freedom to smoke be forfeited? This is an essential point of the current argument and a matter of Human Rights.

You also posed the question:
why should the tiny outdoor areas that are provided for people in some mental health facilities be filled with the lingering stench of tobacco smoke?

They shouldn't!
In my original post I posed the question: is it beyond the imagination of hospitals to provide a well ventilated, secure smoking area outside the bounds of the ward? This could be achieved if there was the will to do so.

As to your hypothetical, I'd recommend harm minimisation as the guiding principle & in this instance, I (a non-smoker) would give the girl a smoke. What would you do?

The imposition of smoking bans in locked psychiatric facilities is just another misguided attempt at Prohibition. Have we learned nothing from previous attempts by albeit well-meaning authorities who have imposed prohibitions of one kind or another in the past? Just how far will the authority figures in these facilities go to ensure compliance with these restrictions? Just how far will the inpatients go to circumvent the prohibition in order to have a smoke?

These bans are too simplistic a response to a complex issue. They are authoritarian and just plain inhumane dressed up in the guise of a positive health measure.

Overall, and on balance which health outcomes will be most beneficial to the patients in the short and the long term?

I do feel for the plight of the nurses who have to face the difficulties that arise in whichever circumstance - Smoke or No Smoke. Therefore the need to view the situation in locked psychiatric facilities as a special case that warrants special attention and management, in order to achieve the best outcome for all. It may take some imagination and it will take some money but it CAN be done!

Indeed, it is "bad medicine" + "bad brain doping (psychiatry)" to suddenly impose forced nicotine withdrawal on anyone unless there is some other majorly compelling reason.

..

But, if the last smoke you dispensed *Rhys* was the one that induced tongue cancer which resulted in the consequential loss of speech for the unintended victim, how would you feel?

..DOH!..

Or what about an individual who has been full on on the weed? They wouldn't be too happy about forced withdrawal either.

You could say, "But weed's illegal!"

To which some would reply, "Well weed never killed anyone, whereas people die from alcohol and cigarettes every day. ( &blows a raspberry for good measure! )"

...

Thus it begs the question as to whose law this is?

Is it a state law, or an internal head of department medical decision?

What indeed, is the view of the *Great BrainDoper?

Rhys Jones,
What about the right to a smoke free environment?

The smoke free policies are not based on depriving of individuals their “right to smoke”, but the rights of the majority to have a smoke free environment.

The utilitarian approach calls for the greatest good to the greatest number of people.

No one is forcing people to give up smoking. They are just being restricted from smoking whilst on the hospital grounds like everyone else. The mentally ill are not being singled out. When they eventually leave the hospital they are free to smoke again. Just like patients in the ICU and CCU.

The crux for some people seems to be more the broader issue of the restrictions placed on people when involuntarily admitted to a mental health facility. This is a bigger philosophical debate than what we are discussing here.

I have mentioned how we don’t allow the use of illicit drugs and alcohol whilst admitted to mental health facilities.

Does anyone feel that we should not be restricting drugs and alcohol from mental health facilities?

Maybe people need to have a look at why they draw the line where they do.

Dooey,
You suggested that a well ventilated, secure smoking area could be provided outside the bounds of the ward. But it would take a more than a little will, money and imagination. It would take a hell of a lot of will, money and imagination, as well as staff.

Maybe you can leave the health department some money and imagination in your will?

And how do you intend to provide the staff supervising these areas with a smoke free work place?

Having all these resources. How would you justify using it on well ventilated, secure smoking areas rather than more beds or other healthier services than smoking areas?

Is this really where people’s health priorities are?

Regarding my hypothetical

Whose smoke are you giving the girl?

Are you digging into your pocket?

As to what I would do: I wouldn’t provide a cigarette. Just as I would not provide alcohol to someone asking for alcohol.

I seem to recall that the Bentley facility had a lovely little outdoor area where people at that time (some 15+ years ago) could quite comfortably have a quiet durry without needing to infringe upon those who did not wish to participate in any form.

..

So, the point here between *Dooey* & *GadPhli* is mute.

..

Both parties, at least at that particular facility, could get what they wanted (after the initial admission period that is)at that point in time.

I gather though from what has been said by some of you here though that ban on smoking in guvment facilities has been extended to the outdoor area of the locked wards as well.

As to your hypothetical, you challenged readers to respond. I responded with what I would do. You have responded with what you would NOT do.

The focus of Rebekah’s opinion piece is the enforcement of a Smoke-Free policy NOT alcohol or any other substance that may be deemed ‘unhealthy’ or ‘illicit’. It’s about smoking bans and their impact on those patients not able to exercise freedom to go outside for a smoke. They are indeed, being ‘singled out’ because their circumstances are unique. What other patients can be held against their will?

To keep banging on about rights to a smoke-free environment for some and the right of others to smoke, and whose rights trump whose, only leads to being at loggerheads. Sometimes there can be no hard and fast rules because of special circumstances. Does a blind person have a right to take a dog into a cafe? Do I?

Perhaps a starting point could be to reopen the existing smokers courtyards, make them all-weather with the provision of an open shelter, install an exhaust system to draw off the smoke and use a self-closing door to prevent smoke drifting indoors. Just as nurses in the infectious diseases ward require safety equipment, then perhaps psych nurses who must supervise in a smoking area could be provided with masks or could supervise from behind glass.

Where there’s a will there’s a way.

Gadphli,
I mentioned earlier that the only restrictions we should be allowed to force upon involuntary mental patients are those that are clinically necessary. Unfortunately for those patients who enjoy drinking alcohol, this means they will not be able to do so during an inpatient admission as there is a powerful link between alcohol intoxication and violence, particularly in the context of a psychotic patient. Same goes for marijuana and speed. Therefore those prohibitions can be justified by the serious risk posed to the patient and others.
However, your assertion that the mentally ill are not being singled out is false. They are the "only" people who are not legally entitled to discharge themselves from the hospital. Even if you are in ICU you are entitled to refuse all treatment and be discharged. The practical consequences are that you may die, but this is every adults right. The only exception is those under the mental health act.
Whilst smoking indoors provides a significant risk from passive smoking to others, this has been banned for many years. The health risks from outdoor passive smoking are so small as to safely be ignored. There have been studies done which measure the amount of environmental smoke in outdoor areas and provided you are 2.7m away from the smoker, there are no detectable amounts in the air.
To ensure the outdoor smoking area is at least 3m away from all other areas should not be too hard to achieve.
The risk of violent assault from a distressed patient is a far greater OSH issue than the tiny amounts of second hand smoke you may be exposed to in an outdoor smoking area.

Posted by Rhys Jones, Friday, 5 August 2011 11:51:40 AM

" ... "

Yes, well said *Rhys* though I additionally wonder about circumstances that *Asylum Seekers* may find themselves in, and perhaps also those of *High Security Prisoners*

..

And of course, an individual in a psychotic state of consciousness who is paranoid and has a propensity towards violence can indeed be a danger to the public and themselves.

(But even problems such as this can be corrected with the "Best of Modern Medicine" shall I say.)

..

In fact,I believe that the prisons of this place are full of them.

..

Again, if this a law of the state, then you may not necessarily expect that it has the best interests of people in mind at all.

Just look at what they have done to children in the past, both the Original Australians, unwanted poms, kids down mines, stealing babies and the list goes on and on right up to what they are currently doing to the children of Asylum Seekers.

Now, I know that some of you like to think that "we are all wonderful" and "reasonable and rationale" and that we have nice little rules about talking nicely to each other etc etc HOWEVER, when you examine the history of this place, as well as some remnant mechanisms of the worst of the "evil" practices of the past, then it ought not surprise you *Rhys* that some people are made to suffer unnecessarily.

“torrent of half-truths, lies, and straw-man arguments”

Nice try, Gadphli.
Indeed, we should be thankful to an intellectual giant such as yourself for highlighting the rules of inference (Puhhhh-leeeez!). Judging by the tone of your posts, you seem to be a shallow thinker very much in the eugenics tradition, e.g., “god complex” – delusions of grandeur, delusions of omniscience, delusions of benevolence. You conjure up “hypotheticals” that blur the issue at hand. Other posters have well picked-up on the pomposity of your poorly-informed opinions.

Are you questioning that antismoking is an aspect of the eugenics framework? Then you’d be wrong. Are you questioning that “nicotine addiction” is a concocted concept serving an ideological goal? Then you’d be wrong. Are you questioning that there are also financial ties to the “nicotine addiction” myth? Then you’d be wrong. Are you questioning that the medical establishment can become a dangerous entity when it ventures into social engineering? Then you’d be wrong – again. You’re very much demonstrating the proclivity of the tyrannically disposed – they are quickly offended by the tyrannical tag.

Gadphli, you’d do well to read the supplied information, although I doubt you’d comprehend its implications. Do you know what bigotry is? Do you know what manifestations of bigotry in the medical establishment look like? Do you know that bigotry is mentally dysfunctional? It addles the thinking: Fanatics don’t think straight, particularly concerning the objects of their bigotry. To use one of your terms, you’re suffering a “pathological coping mechanism(s)”. You’re stuck in a superficial, bigoted thinking and pathologically protecting it as well. In this dysfunctional state can you haughtily declare that all should be made to fit your delusional template for “proper functioning”. Has it ever dawned on you that your antismoking bigotry can compromise the standard of care that you provide those who smoke? This would be antithetical to the ideals of medical care.

Rhys Jones has put it well: “However, the only restrictions that should be applied are those that are clinically necessary. Any extra infringement of their liberty is unjustified.”

Gadphli,
You’re making quite a number of erratic claims. Why do you liken tobacco to alcohol? They are not alike at all. Why do you liken tobacco to illicit drugs? They are not alike at all. Tobacco isn’t even remotely similar to some of the highly potent, consciousness-altering pharmaceuticals that are administered to patients. You even suggest that those who would permit tobacco would also be bound to permit alcohol and illicit drugs!

Then you claim that there should be a “right to a smokefree environment”. Where did this “right” come from – the wishing well at the Castle of Fantasy? The bulk of what is in tobacco smoke is already in the air generally. It is also the same in other forms of smoke, e.g., cooking, heating, candle. And there is no evidence that these constitute any physical harm as they are typically encountered, particularly outdoors. There is evidence, however, that there are now some that are suffering neurotic tendencies, e.g., anxiety reactions, hypochondria, somatization. Antismoking propaganda has manufactured secondhand smoke (SHS) into a bio-weapon-like phenomenon, extraordinarily different to anything else on earth. Those that have lapped up this propaganda are now in irrational belief and fear concerning SHS, hyper-reacting to it as if it was sarin gas. They are the hand-wavers and hand-to-mouthers at the prospect of a whiff of SHS, utterly convinced that a whiff of SHS will drop them dead on the spot. Unfortunately, their neurosis has been promoted by the medical establishment. These neurotics act like a cult whose primary belief is to avoid any SHS exposure and a “right” to a smokefree environment. And officialdom accommodates and reinforces their delusion because this is the primary means to the eugenics smokefree “utopia”.

If that wasn’t enough, you then invoke a contortion of the utilitarian idea of the greatest good for the greatest number. But “greatest good” according to whom? If we used your version, it would be based on incoherent analogies and neurosis.

It would easy to accommodate those who smoke; they were being accommodated for the better part of the last century until the current antismoking crusade took hold in the 1990s. The intent now is to offer no accommodation to smokers whatsoever. Not indoors, not outdoors. This has nothing to do with “protecting” nonsmokers. It is ideologically motivated. It is the attempt, through removing smoking-permitted areas, to “help” (i.e., coerce) those who smoke into [nonsmoking] conformity.

There is NO evidence of harm from outdoor SHS exposure. It may come as a shock to many that there is no evidence indicating harm from SHS *indoors*.

The bulk of the secondhand smoke “research” has been produced by America. There are many groups, e.g., EPA, Office of the Surgeon General, that have gone to great lengths to promote the idea of SHS “harm” indoors. Such groups have been committed, ideologically [eugenics], to a smokefree society since the 1960s, long before any research on SHS, as has the World Health Organization. They are peddling an ideological agenda. Also not recognized is that such groups are advisory organizations, not regulatory ones. They can essentially say whatever they want, however outlandish, because no-one is compelled to pay any attention to anything they claim. This is their legal defense. There was an attempt to bully the actual [Federal] regulatory authority governing indoor air quality – OSHA – into declaring SHS an indoor hazard. OSHA spent a decade – from early-1990s to early-2000s – scrutinizing the available evidence (see Godber/WHO Blueprint www.rampant-antismoking.com ). Although it had an antismoking leaning and there were initially antismokers on the review panel, OSHA finally concluded that it did not consider typical encounters with SHS indoors as hazardous. The only American *regulatory* authority does not view indoor exposure – let alone outdoor – as problematic. This is why there is no Federal indoor smoking ban in the USA. Unfortunately, most governments around the world have bought into the claims of American advisory groups (and their ideological agenda), committed themselves to the WHO Framework Convention on Tobacco Control, and entirely disregarded the important regulatory authority.

Dreamon,

The point is not mute. As you say so yourself, your example only applies to one facility. Unfortunately since the Richmond report, the push has been to close down larger facilities with sprawling grounds in favour of wings or wards attached to general public hospitals. These often have very little in the way of outdoor areas.

Dooey

In regards to my hypothetical I would follow the guidelines set out below.

Flowchart for Managing Nicotine Dependent MENTAL HEALTH & PEC (Psychiatric Emergency Centre) Patients

http://www.hnehealth.nsw.gov.au/__data/assets/pdf_file/0007/49948/Flowchart_-_Nicotine_Dependent_MENTAL_HEALTH__and__PEC_Patients.pdf

Nurse Initiated Medicine Protocol Nicotine Replacement Therapy (NRT)Mental Health Facilities & Psychiatric Emergency Centres (PEC) (July 2008 / Version 1)

http://www.hnehealth.nsw.gov.au/__data/assets/pdf_file/0011/49952/Nurse_Initiated_Medicine_Protocol_for_NRT_-_Mental_Health.pdf

Smoke-Free Mental Health Facilities in NSW - Guidance for Implementing

http://www.health.nsw.gov.au/policies/gl/2009/pdf/GL2009_014.pdf

This is not an attempt at a Gish gallop. I have just added the 2nd and 3rd links for people’s interest and reference.

Dooey,

You are right, no one else is held against their will. That is why they are provided NRT for free whilst they are admitted and given three days supply of NRT on discharge.

Please remember that these are health care facilities we are talking about here. Nurses are there to provide health care not be smoking supervisors. The harm minimisation approach calls for NRT.

There is a will for health facilities to be smoke free environments and we have found a way.

Rhys Jones

I agree, links have been attributed between alcohol intoxication and violence. But what if a patient is not intoxicated? Would you advocate their legal right to drink under controlled conditions, say under 0.05 or even one standard drink a day the same way you advocate their legal right to smoke?

Both are legal, where is the line?

I raise the issue of drugs and alcohol because we have to base our policies on principles. I am interested in why people draw a line against alcohol (even healthy use) on one side but accept smoking on the other.

James08

I think you aptly titled your dissertation
“torrent of half-truths, lies, and straw-man arguments”

But could have added in the title “and other logical fallacies”

Hasbeen

Hello??

Gadphli,
You enquire whether I would advocate an involuntary patient being able to consume alcohol at minimal levels. Yes I would. For example having a beer with dinner would do little harm to themselves or anyone else.
In fact, at a hospital I worked at we gave out mid-strength beer to the patients on the locked ward on Christmas day. I believe that this act really enabled the patients to feel that they were able to celebrate Christmas as every other Australian does and it did not create any problems. The principle according to the mental health act is "the least restrictions on their rights and freedoms. Any arbitrary restriction not justified by clinical need is unacceptable in my opinion.

Rhys Jones,

I agree with your last post.

I see a difference in that there is a lot of evidence to show that alcohol in small amounts has health benefits.

Whereas every cigarette is doing harm and every cigarette you don’t smoke is doing you good.

As a mental health nurse you would be aware of the broader issues that smoking causes in mental health facilities.

Patients often do not have the self control to self manage their cigarette intake.

How and who do you propose controls the supply and intake of the cigarettes?

We used to have a wooden box with everyone’s cigarettes and lighters that we were expected to bring out to the courtyard on a regular basis.

Some staff would even pitch in and buy a communal packet for people that had just been admitted or had run out. I don’t see this as a role or responsibility for any ethical health professional. I know that I highly resented being made responsible for the supply and management of cigarettes.

When lazy staff gave patients a cigarette from their own supply, it created a rod for the back of all other staff and provided an opportunity for staff splitting.

When people were given responsibility for their own cigarettes; People would often chain smoke until they ran out. Then they would harass staff and other patients for cigarettes. Some desperate smokers were violent or threatened violence and used other forms of manipulation. Some offered people sexual favours to get cigarettes.

I concluded that the best solution would be to remove cigarettes from the environment. This would remove cigarettes as a commodity. It would encourage patients to find and develop healthier coping mechanisms and provide staff and other patients with a smoke free environment.

I appreciate that you have a dog in this fight and hope you appreciate that I do too. I have valued all your posts and the integrity of your arguments. Could you please reference the studies mentioning that being 2.7m away from the smoker, there are no detectable amounts in the air? It would be appreciated.

The problem lies in what is understood by health.

Consider the World Health Organization’s definition of health instituted in 1948:
The World Health Organization (WHO) defines health in its preamble as "a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being."

Notwithstanding a few questionable concepts such as “complete”, we can be sure that this definition was a direct result of the Nuremberg trials addressing the horrors of Nazi eugenics. Whatever was directed at Nazi eugenics was also directed at American eugenics. Eugenics is biologically reductionist or, as noted by the Nazis, “applied biology”. The WHO definition attempts to account for the fact that health is more that just absence of disease, more than just a biological phenomenon. It involves other dimensions such as psychological and social.

Given that this WHO definition was put into circulation by Brock Chisholm, the first director of the WHO and a eugenicist, there is always a suspicion as to how the WHO, a medical organization, could potentially warp this definition in the long-term. It could have been an “appeasing” definition, given the anti-eugenics sentiment of the time.

However, what should be noted is the limited scope of the WHO. It does not have a monopoly on health. Being a medical organization, it is intimately bound to the biological level. It is not really a world health organization but a world medical organization – a global medical headquarters. It would have to accept that there are aspects of health that are not its domain or jurisdiction. Just this idea, properly applied, should discourage potentially destructive ventures into social engineering as was seen in eugenics.

Yet with all this history, as we have seen over the last half century, particularly pertaining to antismoking, the WHO and the medical establishment generally, and contrary to the WHO’s very own definition of health, have deteriorated back into a biological reductionist view of health and ventures into social engineering.

(cont'd)

Over the last half century, health has been reduced to the behavioral dimension of eugenics – anti-tobacco, anti-alcohol, prescribed diet, and physical exercise. The WHO adopted antismoking as a societal ideal many decades ago (Godber Blueprint) and now most nations are signed-up to the WHO Framework Convention on Tobacco Control. With this ideological stance comes social engineering, i.e., coercion to conformity.

We have seen smoking bans on hospital grounds where patients have to venture considerable distances in night-attire and in all manner of weather to have a cigarette. This becomes a psychological and social health issue. Indoor smoking bans with no prospect of accommodation have alienated particularly the elderly. This is a psychological and social health issue. Denormalization, a repugnant, vulgar concept very much identified with eugenics, has again come to the fore. Smokers have been incessantly slandered, ridiculed, and terrorized by official, government programs of denormalization. This is a psychological and social health issue. Many nonsmokers have been manipulated into irrational fear and bigotry to advance the ideological cause. This is an issue of psychological and social health. Smokers are being bullied out of normal social life on a purely ideological basis. This is an issue of psychological and social health. With this propaganda barrage, medical care professionals are demonstrating a cruel, bigoted streak – again - that can compromise the medical treatment of those who smoke. This is an issue of psychological, social, and physical health. Not only are psychological and social health issues important in their own right, but these can also have detrimental ramifications for physical health. Health has again been reduced to quantification, dollar cost-benefit analyses, another eugenics trait.

Everywhere we turn health has again been reduced to only a biological phenomenon (e.g., behavioral) and with the [eugenics] intent of social engineering. “Get healthy”, “he’s looking after himself”, “I work out” all pertain to physicalism. In the obsession with physicalism, psychological, social, moral, and ideo-political aspects of health have been brutalized and discarded - again.

For anyone interested in a brief commentary on the history of eugenics antismoking and its connection to contemporary antismoking, see following link with particular attention to the comments posted by “Magnetic”:
http://cfrankdavis.wordpress.com/2011/06/23/the-nazi-antismoking-legacy-1/

Gadphli, you needn’t bother. It will all seem like Gish gallop to you.

1.
Let’s say the government decided to accept some precepts of, for example, Mormonism. Let’s say it accepted the “no smoking” maxim. It is then declared that patients at mental health facilities will not be permitted to smoke indoors or out due to this Mormon leaning. There would certainly be outrage. It would be pointed out that one cannot force patients to accept ideological/religious precepts as a condition for medical treatment. Yet something of this order has been allowed to occur. The medical establishment has again dangerously deteriorated into the behavioral dimension of eugenics – anti-tobacco, anti-alcohol, dietary prescriptions/proscriptions, physical exercise requirements. The most virulent of these currently is anti-tobacco. Eugenics is a cultic framework with a peculiar world-view and an ideological agenda. It has infected government health bureaucracies – unelected civil servants – that have duped governments over the last few decades into accepting eugenics beliefs as societal ideals, e.g., anti-tobacco.

Having accepted anti-tobacco as a societal ideal, government has determined that smoking will not be permitted indoors or out at, in this case, State mental health facilities. This places smoking patients who are not permitted outdoors or beyond facility grounds in a nasty predicament. They will be forced to quit smoking for the duration of their stay which may be days, weeks or months. They are being forced to accept an [eugenics] ideological precept as a condition of treatment. The circumstance is not only untenable, it is extraordinarily perverse.

As indicated in the article, a stay in a facility produces many of the reasons why people smoke, and most probably even magnified. Understandably, just the prospect, let alone the actuality, can cause great distress to smoking patients affected. In chasing deranged ideology – the smokefree “utopia” – the medical establishment and governments are jeopardizing patients’ immediate psychological health: They are putting ideology before patients’ health.

2.
The current antismoking crusade was put into motion in the mid-1970s under the auspices of the UN agency, the World Health Organization (see Godber/WHO Blueprint www.rampant-antismoking.com ). A small group of unelected people operating under the auspices of an organization with no jurisdiction determined for the whole world that tobacco-use should be eradicated. Over the ensuing three decades these “representatives” have managed to manipulate governments around the world to adopt the cultic belief of antismoking as a societal ideal; most countries are now signed-up to the WHO Framework Convention on Tobacco Control. In the 1970s this group was already speaking of denormalization/stigmatization of smoking/smokers and of indoor and outdoor bans years before even the first study on secondhand smoke. The Godber/WHO Blueprint is an ideologically-driven global tobacco-use eradication program.

The Blueprint discusses indoor/outdoor smoking bans at medical facilities. It also recommends the employment of only nonsmokers in health care, i.e., employment discrimination, so that health-care providers present as “exemplars” of healthy living, a sort of medical “priesthood”. Apparently, doctors and nurses can be bigoted, incompetent, adulterous, overweight, etc. These are inconsequential. It’s their antismoking stance that distinguishes them as “exemplars of health”. And the expectation was that this would set a good example for other industries to follow suit.

There is now all manner of discrimination directed at smokers as a consequence of the government-supported, eugenics propaganda onslaught. We now have indoor smoking bans and a growing number of outdoor bans, e.g., parks, beaches, entire university campuses. There are compounded extortionate taxes on tobacco. There are growing instances, particularly in the medical establishment, of employment discrimination against smokers: Since early-2000s, WHO employment policy is to refuse employment to smokers. There are growing instances of smokers being denied medical treatment and housing. And all of this discrimination is progressive coercion to conformity – quit smoking or the State will make life very difficult for you.

3.
Godber was not an avowed eugenicist. [The term “eugenics” has not been used post-WWII. The current term is “healthism”, i.e., eugenics by another name] But Godber’s view of smoking and what should be done about it was very much in the eugenics tradition. The Blueprint involves the same eugenics personnel – physicians, biologists, pharmacologists, statisticians, behaviorists. It involves the same eugenics “behavior” obsessions, e.g., anti-tobacco (negative eugenics). It involves the same repugnant eugenics methodology, e.g., propaganda/denormalization. It involves the same eugenics aspirations to societal rule, i.e., fascism. It involves the same destructive consequences.

So the circumstance of mental health facilities needs to be understood in the greater context of a well-funded, government-supported, global eugenics assault on tobacco-use. In mental health facility, this deranged ideological antismoking stance has produced a tormenting (even torture) of patients who are already vulnerable, a subgroup of staff who irrationally believe they are in “danger” from SHS – even outdoors, a subgroup of staff with bigoted tendencies towards patients who smoke – which can further compromise patients’ treatment, and a subgroup of staff that have maintained their sensibility, can see the damage being wreaked, but feel powerless to do anything about it. Unfortunately, this is what deranged ideology and fanaticism produces. And eugenics already has a track record of producing this sort of damage and far, far worse. And all of this distress and dysfunction could be easily alleviated – remove the ban. Then, remove the people who instituted/supported the ban and remove all government support for ideological antismoking before any further damage is done.

4.

In pushing their deranged world view, contemporary eugenicists are very much in line with their predecessors. They use lies, exaggeration, manipulation, pitting groups against other groups to achieve their goals, e.g., propaganda/denormalization. It is a cultic framework where participants convince themselves that much is permitted in the interests of a eugenics-defined “good cause”, i.e., the end justifies the means. Because nothing other than biology registers on their perverse definition of “health”, they do not recognize, or couldn’t care less about, or may even delight in, their destructive influence on psychological, social, moral, and ideo-political health. And like early last century, there are many – essentially the “educated”/wealthy classes - that have jumped on the bandwagon, giving it considerable momentum. There are now groups around America and the world stumbling over each other to be the first to institute the most draconian, widespread smoking bans for a eugenics-defined “healthier” society. There is nothing healthy about this circumstance.

It should be noted that many neo-eugenics thinkers wouldn’t even be aware that they are so. Most wouldn’t know what eugenics refers to or that antismoking has a history, and a sordid one at that. They simply do what they are trained to do (e.g., in Public Health courses relying on the medical model) with little or no questioning. This makes them particularly dangerous to society because they’ll simply be repeating disastrous, painful errors of the past, as they are already demonstrating in the current antismoking circumstance. They should be referred to as eugenicists because that is the mentality they are demonstrating and it is a quick historical reference/reminder of the catastrophe they can produce.

The progressively more draconian, multi-faceted measures directed at smokers have considerable, compounding, detrimental consequences such as economic hardship, isolation, baseless guilt, antagonism, frustration, confrontation, etc. This incessant coercion and bullying is benignly referred to by the perpetrators as “help” to quit which motivates them to provide even more “help” to quit. Note, too, that this healthist fascism, demanding conformity through punitive measures, is occurring in one-time relatively-free societies; the ideo-politics of these countries has been warped.

Gadphli,
Here is a link to that study on outdoor tobacco smoke measurements for you to look at.
http://exposurescience.org/pub/preprints/Klepeis_OTS_Preprint.pdf
I may have misrepresented the finding in saying "no tobacco smoke was detectable at 2.7m". In fact they could still detect tiny amounts of smoke under certain conditions, (downwind, multiple smokers) but these were barely above background levels and so highly unlikely to pose any meaningful risk. It clearly shows that it is not impossible to create a smokers area that poses little risk to non-smoking staff.
Remember that occupational health and safety is not about absolute elimination of every risk. If it was then there would be no mental hospitals at all due to the risk of assault on staff and other patients. One must weigh the risks and benefits of all policies. With this one, the risks of inflicting unnecessary suffering on patients, unnecessary aggression toward staff and severe disruption of the therapeutic relationship, far outweigh any possible risk from tiny amounts of environmental tobacco smoke in an outdoor area.
As one of the people who have been required to enforce this policy, I am well placed to give a first hand account of the effect on patients, and I can tell you, it is not good.

Thanks Rhys,

After a skim of the article it would appear that you have only negligibly misrepresented the findings. Unfortunately in a lot of modern mental health facilities the court yards are very small and staff are expected to be within arm’s reach of clients when on the highest level of observation.

You stated that “there have been studies done which measure the amount of environmental smoke in outdoor areas and provided you are 2.7m away from the smoker, there are no detectable amounts in the air.” This implies that there was number of studies supporting your statement.

In regards to your claims of “the risks of inflicting unnecessary suffering on patients, unnecessary aggression toward staff and severe disruption of the therapeutic relationship, far outweigh any possible risk from tiny amounts of environmental tobacco smoke in an outdoor area.”

I am yet to read any quality studies that support this. There is certainly a lot of anecdotal conjecture amongst staff that this is the case. But not much evidence to support this. The results of one study actually stated “There was no increase in aggression, use of seclusion, discharge against medical advice or increased use of as-needed medication following the ban”.

http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1614.2005.01697.x/full

I can’t access the full article from my home computer, but I am confident you could access it through your CIAP (clinical information access portal) or your states equivalent.

If it is possible to find a way for people to smoke on a mental health unit that adheres to the following, I guess I could reluctantly concede.

1. Staff and other patients are not exposed to any smoke on hospital grounds.

2. Health professionals are not responsible for the supply and/or control of cigarettes.

3. Government funding is not used that could be better spent on other more important health priorities.

Unless a very wealthy philanthropist can be convinced that this is a health priority. I can’t see it happening.

Smoking is the leading cause of preventable deaths in the world.

Smoking is inextricably linked to poverty.

How can any mental health facility justify smoking?

The point is not only mute at the W.A. Bentley facility, but also at the Alma Street facility in Fremantle.

..

So it raises the issue of the legal basis for denial does it not? In fact, it may not be a direct issue of the denial of the right to smoke at all. But rather what is being denied is the right to smoke within the confines of certain guvment facilities.

So, as interesting as some of the arguments that are being made are, they may not have any relationship to the legal basis of the denial as it is currently being practiced, but rather just a possible basis for how the law would be preferred to be by certain people.

Thus, what the real issue is is the nature of the locked ward itself. Now, I have already referred to 2 facilities which at least in the past had grounds sufficient for smokers to be accommodated without concurrently generating a health issue for other persons.

I expect that there are more, notwithstanding *GadPhli's* biased assertions to the contrary.

..

Of course, the nature of the economic rationalism may well be leading to a situation where there are no longer sufficient open areas for smokers to be accommodated.

Of course, in such facilities it is unlikely that the residents are getting appropriate amounts of exercise and levels of natural light too though.

..

*Rhys* seems to represent, for want of a better term, "Old World Medicine" with compassion and a fundamental respect for the rights of others.

*GadPhli* on the other hand appears to be the wanton instrument of whose who are obsessed with getting their own way, irrespective of whose rights they have to trample on.

Essentially, smoking is lawful, though counterpoised to this is the fact that Australia is in reality a discriminatory society, which constitutionally retains the race power, amongst other foul mechanisms.

DreamOn
Loved your post.
Gadphli,
That paper you referenced was a review of the literature. I have read the study that reported no increase in violence, aggression or discharge agaisnt medical advice. It was an American study.
Of the sample of 176 patients in the study only 5.6 percent of them had schizophrenia.
That is a pretty major contrast to a locked ward environment in Australia where upwards of 60% of the patients have schizophrenia (my estimate and probabaly on the low side).
Depressed people who are forced to stop smoking, while they may be distressed, they are unlikely to be aggressive. It is entirely different for people suffering schizophrenia.
You make three points
1 government money should not be used to buy cigarettes. I do not know of any hospital that still supplies cigarettes to patients. That must have finished at least 20 years ago. Patients must pay for them themselves and usually get relatives or friends to bring them in.
2 Staff and others should not be exposed to second hand smoke. The policy now in place appears to have increased the amount of smoke others are exposed to, as smokers simply smoke in front of the buildings and in access ways rather than isolated smoking areas.
3 Staff are not responsible for providing tobacco. They do not provide tobacco as I have already stated. Friends and family bring it in for them.

Rhys,
The Klepeis study you refer to only indicates that there is evidence of smoking (e.g., particulates) where smoking occurs (an expensive study just to indicate that!). The study does not assess hazard, although it makes quite a number of wild, agenda-driven speculations about “potential” hazard.

Klepeis’ study is referred to in an article indicating a California city’s intent to institute outdoor smoking bans.
http://wehonews.com/z/wehonews/archive/page.php?articleID=5304

Klepeis admits that his study does not indicate harm from outdoor smoke exposure. When it was apparent that there is no health basis for outdoor bans – bearing in mind that there have been only two studies conducted that do not address hazard, the emphasis was then shifted to a moralistic (ideological) basis, which is what antismoking has actually been about from the outset:
“Face with that evidence, or rather, lack of evidence that brief exposure to outdoor second-hand created a "significant" health risk, smoking ban advocates responded that rather than prevent deaths that may or may not result, they sought to use the legislation to keep smoking from kids' view, out of fear that seeing it done in public influences children to try it.”

California has led the way in antismoking post-WWII. There is now a frenzy – a madness - to institute outdoor bans (e.g., parks, beaches) and even apartment complexes.
http://www.ocregister.com/news/smoking-238203-city-parks.html
http://www.msnbc.msn.com/id/41896121/ns/health-health_care/
http://www.presstelegram.com/news/ci_16094607
http://www.ocregister.com/news/smoking-284833-park-ban.html
http://www.mercurynews.com/breaking-news/ci_16567116?nclick_check=1

It must be understood that this is all ideologically-driven. It has nothing to do with protecting nonsmokers from SHS “danger”, and never has. This is not surprising in that California was a eugenics epi-centre pre-WWII. It conducted more, by far, sterilizations than any other American state. California recently formally and publicly apologized for its eugenics past.
http://www.fredonia.edu/prweb/releases/eugenics.htm
http://hnn.us/comments/9561.html

Although it may have apologized for sterilizations, California has simply continued eugenics along the behavioral dimension, specifically anti-tobacco.

(cont'd)
Some background on Klepeis:
Klepeis is part of a small antismoking clique conducting antismoking “research”, e.g., Repace, Glantz, Winickoff. Stanton Glantz has been in antismoking since the beginning in the 1960s. He trained as a mechanical engineer. Given his antismoking zealotry and although he is not a cardiologist, he was given a Professorship in Cardiology at the University of California, San Francisco, to add “legitimacy” to his [delusional] antismoking claims. He has also conducted economic research claiming that there is no detrimental economic impact from smoking bans even though he has no economics qualifications. He also started what is now known as the “heart miracle scam” (see http://velvetgloveironfist.blogspot.com/2011/08/heart-miracle-scam-revisited.html ). Repace refers to himself as a “health physicist”, whatever that means, and a “secondhand smoke expert”. He is best known for the claim that it would take tornado-force ventilation to clear indoor tobacco smoke. Klepeis trained in civil engineering. He refers to himself as a “human exposure scientist” heading up the “emerging science” of human exposure which is “at the nexus of traditional physical and social science fields -- including physics, chemistry, sociology, psychology, and geography.” So we have a civil engineer that believes he has become an “expert” in many fields, including psychology and sociology. [You couldn’t make this stuff up!]
http://stanford.edu/~nklepeis/

The fact of the matter is that these people are fifth-rate – if that - academicians that would have otherwise had very short careers. But Tobacco Control and the lucrative funding available if one is willing to prostitute their academic position for an ideological cause has afforded them a comfortable career. If they keep coming up with the “right” study conclusions, they’ll keep attracting funding.

Here are a few more of Klepeis’ studies:
http://tobaccocontrol.bmj.com/content/20/3/212.abstract
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3007589/
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WDS-52G1S1Y-1&_user=10&_coverDate=05%2F31%2F2011&_rdoc=2&_fmt=high&_orig=browse&_origin=browse&_zone=rslt_list_item&_srch=doc-info(%23toc%236774%232011%23998889995%233148735%23FLA%23display%23Volume)&_cdi=6774&_sort=d&_docanchor=&_ct=22&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=a07b7b398e8d77e4bd56ab06ac1036b2&searchtype=a

There is a particular pattern to all this “research”. Firstly, the studies only indicate that there is measurable evidence of smoking (e.g., particulates) when smoking occurs. Great expense is incurred to demonstrate the obvious. Secondly, this clique of “researchers” refer to each others’ questionable research as the basis for wild speculations of smoke “hazard”. Thirdly, they invariably invoke the fraudulent claim of “no safe level” of tobacco smoke, which violates the fundamental toxicological maxim of “the dose makes the toxicity”. If there is no safe level of tobacco smoke, then there is no safe level of any smoke (e.g., cooking, heating, candle). Since many chemicals in smoke are already in “smokefree” air, then there is no safe level of air generally. There are potential carcinogens in drinking water. So there’s no safe level of drinking water. And the same can be said of many foods. There is much research funding being squandered on the basis of this fraudulent, inflammatory claim. Fourthly, these researchers never refer to the OSHA ruling on indoor tobacco smoke, which indicates that typical indoor encounters with tobacco smoke are not problematic. Particular constituents of smoke are well within permissible exposure limits (PELs). OSHA is the only organization to be taken seriously concerning indoor air quality – it is the Federal regulatory authority. Fifthly, even though there is no evidence of hazard, the research invariably concludes that smoking bans should be instituted. The only purpose of this research is to contrive findings to support smoking bans, giving the appearance of a “scientific basis” for such bans.

It could be asked how such a sham of research could attract funding. There’s an easy answer. The Master Settlement Agreement in America and tobacco taxes in California, which smokers both pay for, has created three major research reserves involving many hundreds of millions of dollars - FAMRI, TRDRP, and Legacy. These reserves are administered by antismokers to fund antismoking “research”. These are not interested in science; they are interested in the “right” results to push the agenda. You’ll typically see FAMRI funding for studies conducted by Klepeis, Repace, and Winickoff.

Gadphli: “I am yet to read any quality studies that support this.”

http://www.news.com.au/psychiatric-patients-risking-lives-for-a-cigarette/story-e6frg12c-1226028565071?from=public_rss
http://www.nzherald.co.nz/opinion/news/article.cfm?c_id=466&objectid=10741162
http://www.tobacco.org/news/308445.html?show_intro=0&records_per_page=100

Let’s say for argument’s sake that smokers weren’t flipping right out (although they are). What if an involuntary patient simply asked, “I’d like a cigarette”? Who do you think you are to stand there and declare, “No, because I don’t approve of your [legal] habit”?

“Staff and other patients are not exposed to any smoke on hospital grounds.”

Why? It’s now been indicated that there is NO evidence of harm from exposure to smoke outdoors. It’s even been indicated to you that the regulatory authority in the USA – OSHA – does not view typical exposure to SHS indoors as problematic.

“Health professionals are not responsible for the supply and/or control of cigarettes.”

Why? Is it beneath you handling those “terrible” objects? I thought that you were supposed to be of service to patients, not patients having to accommodate ideological whims and inflated egos. You were quite happy to invoke “where there’s a will, there’s a way” when your goal was instituting antismoking policy. Why would you not invoke the same maxim in reasonably accommodating patients who smoke? See also Rhys Jones.

“Government funding is not used that could be better spent on other more important health priorities.”

Why? Government spends a copious amount on antismoking propaganda that promotes mental dysfunction, particularly amongst nonsmokers. This could be better used in not tormenting mental patients who smoke. Smokers also pay an obscene amount on tobacco tax. See also Rhys Jones.

“Smoking is inextricably linked to poverty.”

For the 70 years preceding the current antismoking crusade, it wasn’t. What is demonstrated is how cowardly the current affluent are when a “crusade” starts up, and it is usually the affluent and “educated” that lap-up the propaganda and are the major driving force behind these destructive, “society-fixing” crusades. What do you make of compounded extortionate taxes on tobacco as a [punitive] “incentive” to quit? If smokers of lower income don’t quit, they’re made even poorer. How bright is that as a “health promoting” measure?

Hi James08,
You are right in stating that there is no evidence of actual harm from outdoor tobacco smoke. The ban is ideologically driven and simply using OSH as a mask. I merely quoted the study to show that it is quite possible to have outdoor smoking areas that do not expose bystanders to significant amounts of smoke.
Your point about poverty and smoking is also very valid.
Very few wealthy people smoke now-a-days. Those with serious mental illness are almost universally poor. Having to pay $100+ per week for smokes renders them much poorer still. Often they go without decent food, clothes and other things that the rest of us would class as essentials in order to afford their habit.
The excessive taxes on smokes are also ideologically based. Smokers do not cost the country more money than non-smokers. Given that they die on average ten years earlier, and these ten years tend to be the least productive years and most costly in health care, aged care etc, smokers are in fact saving the taxpayer a lot of money as well as contributing a lot of extra tax. (there is research to back this up)
All of us are going to die of something. Smoking related illnesses are no more expensive to treat than illnesses related to age, obesity or anything else.

Now, what about when your partner comes to visit during approved visiting hours and wants to provide a loving "full service."

I'll have you know that the bi-releases of orgasm dissipate excess dopamine and this can be a great complementary therapy for those suffering schizophrenia.

..

Hey! But, even when you can get a smoke, there may still be a "No Cigar" policy. LOL!

;-)

..

What's the current practice in this regard?

Gadphli: “Smoking is the leading cause of preventable deaths in the world.”

Yep. That’s been an often-made claim over the last few decades. I suppose you think that one is accurate too? Well, it isn’t. It’s just another in the long list of fraudulent claims made in the “antismoking cause”.

The actual leading cause of preventable death and disability, and associated costs, is the medical establishment. It’s referred to as iatrogenesis or iatrogenic effect. It usually refers to adverse drug reactions from *properly* administered drugs, medical errors (e.g., misdiagnosis, surgical errors), and the consequences of poor care (e.g., resulting infections in bed sores from poor care of the bedridden).

In the USA, the smoking “death toll” is estimated at 440,000 per annum. This estimate is based on lifelong risk of tobacco-use that also involves hundreds of other correlated risk factors. For all intents and purposes, it is a statistical death toll where underlying causation in many instances is highly questionable. The causation in iatrogenesis is far, far clearer. For example, a person can go into catastrophic failure leading to death/disability within minutes of being properly administered a drug. The estimated iatrogenic death toll in the USA is between 780,000 and 1,000,000. This is well over a third of all deaths per annum and dwarfs the tobacco “toll”.

“We estimated that in 1994 overall 2216000 (1721000-2711000) hospitalized patients had serious ADRs [adverse drug reactions] and 106000 (76000-137000) had fatal ADRs, making these reactions between the fourth and sixth leading cause of death”.
http://www.ncbi.nlm.nih.gov/pubmed/9555760?dopt=Abstract

Including more sources of iatrogenesis:
Doctors Are the Third Leading Cause of Death in the U.S.
Cause 250,000 Deaths Every Year
From Starfield, B. (2000) Is US Health Really The Best In The World? Journal of the American Medical Association, 284 (4), 483-485.
http://www.naturodoc.com/library/public_health/doctors_cause_death.htm

Including even more sources of iatrogenesis:
Null et al. (2003)
DOCTORS ARE THE LEADING CAUSE OF DEATH IN THE USA.
Cause 780,000-1,000,000 Deaths Every Year
http://www.webdc.com/pdfs/deathbymedicine.pdf

‘Global Trigger Tool’ Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured
http://content.healthaffairs.org/content/30/4/581.abstract

Rhys
Thank you for your astute comments and your humanity.

If you have the time, check the comments section of the following blog thread.
http://tobaccoanalysis.blogspot.com/2011/08/gallup-poll-shows-increasing-lack-of.html
You will find a photo from circa 1915 about half-way down the comments section. The photo shows a large anti-tobacco billboard. At that time, eugenics dominated proceedings in America. Although secondhand smoke “danger” had not been concocted yet, the sentiments and words on the billboard could be seamlessly transposed to modern day: It is the same mentality. In other words, we’ve regressed about a 100 years.

The problem is that we really don’t understand the full scope of the eugenics framework. Eugenics has two aspects. The first and primary aspect, and the one that most are familiar with and which solely appears in descriptions of eugenics, is the racial/heredity/breeding aspect. The second aspect, and one that most are not familiar with, is a behavioral/environmental aspect, e.g., anti-tobacco, anti-alcohol, dietary prescriptions/proscriptions, physical exercise. Post-WWII, the American eugenicists simply stopped using the “E”[ugenics] word due to its horrific connotations, de-emphasized the racial dimension - for obvious reasons, and dispensed with their flawed “heredity trees”. But they continued with the behavioral aspect. By the late-1970s it was apparent that a movement was afoot that was obsessed with physical health, e.g., anti-tobacco, anti-alcohol, dietary prescriptions/proscriptions, physical exercise. Since the “movement” was nameless and the commentators of the time were not familiar with eugenics, they termed the movement “healthism”. Yet healthism is nothing other than the behavioral dimension of eugenics.

Post-WWII, the heredity dimension was taken up by genetics research. The last 60 years has resulted in the Human Genome Project which is now housed in the very same building complex in Cold Spring Harbor, New York, as the original Eugenics Record Office.

Some blogs you might keep your eye on, if you’re not aware of them already:

Blog run by Professor Michael Siegel. Michael is very much a Tobacco Control advocate but he has attempted to distance himself from the more outrageous claims of Tobacco Control (i.e., anti-tobacco).
http://www.tobaccoanalysis.blogspot.com

Also,
http://www.velvetgloveironfist.blogspot.com
http://dickpuddlecote.blogspot.com

I think that there should be an encouragement program for those who want to attempt giving up.

I also think that the reasons for regulating smoko time outweigh those to the contrary. Of course, getting the dosages correct is important, and to some extent may have some bearing on the overall recovery of patients.

And, as some poor wretched poppets may have been "in the gutter" without an income for a while, I think that the hospital should take charge of the durrie supply.

Of course, cigarettes with the addition of "after burner" chemicals in them and or additional sh!t that makes them more addictive could also be weaned out.

Something economically creative perhaps, like a simple direct debit on the CentreLink income of the inmates should suffice.

Of course, if "informed legal consent" is an issue then perhaps a legislative tweak to provide an exception for a "Legal Guardian"

(ie the hospital or facility where the patient is)

to authorise these types of matters.

An expansion of the role of the social workers to provide a more complete package solution and orientation program pre graduating to "out patient" status would also make for better outcomes all round I believe.

..

Hospital Grade durries!? HaHaHa