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.

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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.