There has been a big debate in the background that I have seen for the last 10 years. Patients say it’s their ‘Human Right to smoke’. I say no “it’s not your Human Right to smoke.”
Many mental health staff believe that smoking of tobacco is ‘therapeutic’ because it relieves anxiety, reduces risk of violence, and risk of self-harm. I often argue that there is no such evidence, and that smoking is a ‘killing activity’ because the packets of tobacco are all labelled ‘smoking kills’. Furthermore I have seen no evidence that smoking is a treatment as defined in S145, for any mental disorder.
The ‘will of Parliament’ is clear that in restricting or limiting certain Human Rights, the purposes of detention are for treatment. S17 is a relaxation of conditions of detention for a treatment purpose.
Giving leave to a person suffering with schizophrenia who is craving alcohol or some other addictive substance falls into the same net or argument, as far as I am concerned. The difference of course is that tobacco use has not been proved to worsen mental health (save in the exception of people on clozapine where serum levels may fall at cause indirect problems).
But then there is the extended argument that vaping (of European standard approved vapes), is ‘therapeutic’, so patients should be given S17 leave to vape. The overall argument is that reduction of stress withdrawal from nicotine (via vapes not labelled as killing) is adjunctive to treatment.
I need arguments for and against from others, to clarify my thoughts on this matter. Please help.
I think s.17 is simply the legal authority for someone who is detained in a hospital to leave that hospital temporarily. I don’t quite like the idea that it must always be for some positive, identifiable ‘therapeutic purpose’ because I think it is also the way that hospitals respect a degree of personal autonomy and limit their everyday interference with rights to what is necessary (by rights I don’t mean a right to smoke, but a right not to be physically detained more than is necessary). I’d suggest approaching the question from the other way around: is there a therapeutic rationale for not allowing someone leave in a particular circumstance? Taken that way around, the question of a person smoking or vaping seems to me to be not very relevant. If being off the ward would be acceptable were smoking/vaping not the issue, then I don’t think that adding smoking or vaping adds very much to the decision.
Or, if it makes more sense to think of it this way, the therapeutic purpose of detention under the MHA is to give someone back their autonomy: to make continued detention unnecessary. So the very act of allowing leave from a ward always has a therapeutic purpose to a greater or lesser degree
My son is currently “allowed” to vape and these are sold in the hospital shop. But the hospital has told all patients that vaping will be banned in 8 months. I have seen a benefit to my son of relieving boredom and anxiety through vaping while at the same time being concerned about the risks of cancer. Interestingly though, my son is almost relieved that in 8 months he won’t have an option to be tempted to vape.
Having never smoked I feel that patients are a vulnerable and bored group to provide knowingly addictive substances to (legal or not). It could be argued that this vulnerable group is being exploited via the enablement of the MH system by a profit-making industry (known ironically to increase burden on the NHS).
Is there a parallel with a diabetic unit selling chocolate bars from a vending machine in the corridor to the ward?
MH settings should be an opportunity to focus on full health and nutrition. When one is sectioned to care the responsibility for that care is with the professionals who - I would hope - practise under the hypocratic oath which includes protecting patients’ health and well being.
It is a very sensitive topic.Our patients say it is similar like drinking tea/coffee or eating chocolates/fast food etc,it is an addiction,yes it is an anxiolytic,appetite suppressant etc,we need to be very careful of the language we use.Patients go on Sec17 leave to do shopping,to go the bank,to go home for a few hours etc or to go to the café/canteen etc.but not just for smoking.