Smoking rights for Mental Health Consumers
NSW Health has imposed a smoke free policy on mental health locked facilities, removing exemptions. The vulnerable patients are traumatised. Eighty percent smoke. We support their dignity and 'right to choose' - personally controlled since European settlement. Media release 19/3/09 Smoking submission But forced medication has increased.
The last times we drew the line was for the Prisoners Right to Vote and the Long Bay forensic patients. See our campaign successes. Here is the dedicated website. www.righttochoosealliance.com.au
JA very strongly believes that to impose such a ban on a particularly vulnerable section of society when the same ban is not imposed on the larger community, is not only undemocratic but also imposes a disproportionate level of suffering on those who are already suffering enough.
We support the right to choose and not be forced to lose the most important personal pleasure that 80% of patients enjoy and currently control. We have been provided with considerable evidence of the benefits for mental health patients of being allowed to continue smoking when combined with smoke free areas to protect the health of those who do not smoke.
In our submission, it would be far better for the Department to introduce smoking intervention education programs and tools such as nicorettes and patches for mental health patients in these institutions, than banning smoking altogether. In conjunction with the people and organizations that have contacted us, we have prepared a response in the form of a submission to the Taskforce.
We are outraged that whilst they remove the drug that patients enjoy - tobacco - the Health authorities force their drugs upon the same patients as they show symptoms of distress. This involuntary treatment is in breach of international covenants, best practice and the law itself. Download the new analysis. Involuntary medication
The Right to Choose Submission to NSW Smoke Free Mental Health Taskforce
(download pdf with graphic from top paragraph)
In late 2007, NSW Department of Health established a taskforce to bring
together a committee of experts and stakeholders to advise the Department
on the implementation of the NSW Health Smoke Free Workplace Policy in
NSW Health mental health inpatient facilities.
The brief of the taskforce is to make recommendations for progression to
the implementation of smoke-free policies in such facilities following the
enactment of the Smoke Free Environment Act 2000.
This is a submission to the taskforce.
2. Executive Summary
In our submission:
(a) we do not support smoking and accept that it is a significant health issue;
(b) in the context of smoking and mental health consumers, we are of the
view that the most appropriate way of discouraging this group from
smoking is through voluntary smoking intervention programs such as selfhelp
groups, support phone lines, access to quit phone lines, appropriate
educational materials and the use of tools such as nicorettes and patches.
We believe access to these materials should be made available as an add
on to the mental health treatment programs prescribed in mental health
institutions for consumers who smoke; and
(c) to impose a compulsory requirement that mental health consumers must
give up smoking is wrong because:
l it targets a particularly vulnerable section of society with bans that
the government will not impose on the larger community; and
l it imposes a disproportionate level of suffering on those who are
already suffering enough.
3. Arguments in support of the right to smoke
(a) Why the debate?
The current position is:
* there is no legislation in Australia prohibiting smoking and it
remains a pastime enjoyed by millions of people in this country;
* there are restrictions about smoking in certain locations because of
health reasons associated with passive smoking.
* the NSW government has legislated to address that issue by
requiring certain businesses to provide smoke free areas and by
providing itself designated smoking areas in its own government
* health experts have agreed that providing smoke free areas
satisfactorily addresses all health concerns associated with the
dangers of passive smoking; and
* the government has already provided designated smoking areas in
many of its facilities in NSW including hospital and mental health
Given these factors, the most likely reasons for the NSW government to
propose prohibiting smoking in mental health facilities is either to:
* impose its own moral criteria on peoples right to choose to smoke;
* save government money from the cost of providing designated
smoking areas in some of its own facilities for the purpose protecting
non smokers from the dangers inherent with passive smoking and
thereby avoiding litigation.
Imposition of moral criteria
Philosophically, by not prohibiting the act of smoking, the NSW government
is saying not only it is legal to smoke but also that people have the right to
choose to smoke.
If the government is imposing a ban on smoking for moral reasons, our
submission is that it is wrong for government to try and impose its own moral
criteria on a section of the community who would otherwise have a right to
smoke, just because government believes it is wrong. It is discriminatory to
target one group and not another and strikes at the very heart of democracy to
try and take that right away.
Government may well have an argument that smoking adversely affects
peoples health, but until it completely prohibits smoking, it is wrong for it to
single out a group of people such as those in mental institutions to somehow
protect them from themselves.
The proposed ban is even more unfair when you take into account the group
targeted. Mental health patients often spend years and in some cases, their
whole lives in these types of facilities. In a very real sense, the facilities become
their homes. The rest of the population is not prohibited from smoking in
their homes. Why should the government single out a group of disadvantaged
people to whom it owes a duty of service to take away a legal right to choose
The fact that government at the same time it is trying to prohibit smoking
in a certain section of the population because it says the practice is harmful,
also lives from the taxation revenue provided from that practice, makes the
proposed ban even more indefensible.
If cost saving for the purpose of protecting non smokers from passive smoking
and thereby avoiding litigation is the reason for the proposed ban, then
government should be upfront about the cost of not implementing the ban and
providing reasonable protection to non smokers against the perceived dangers
of passive smoking.
In our view, to take away a right available to the rest of the community by
targeting an already disadvantaged group of citizens simply for financial
reasons when there is no evidence that such costs are prohibitive is, in light of
this and the other arguments advanced in this submission, simply wrong.
Mental Health Act
In our submission, the Taskforce should keep in mind the following sections of
the Mental Health Act (2007):
l Section 3(d) which states:
The objects of the Act are [to provide for the care etc of the mentally ill]
.while protecting the civil rights of those persons, .; and
l Section 68(f ) which states:
Any restriction on the liberty of patients and other people with a mental
illness or mental disorder and any interference with their rights, dignity
and self respect is to be kept to the minimum necessary in the circumstances.
(b) Discourage Voluntary Patients
The right to smoke is a right enjoyed by many. To take that right away will
be regarded by many as a significant loss. Prospective consumers who would
otherwise voluntarily attend mental health facilities, are much less likely to
attend these facilities if they know they will not be able to smoke.
(c) Significance of Smoking in Mental Health Facilities
It is well established that to many people smoking is a very important activity.
For many in mental health facilities where the stresses are much higher than in
the normal world, it promotes social connections in the sharing of cigarettes.
For others such as those in jails, it is the most important activity open to
them. Many spend all their weekly buy up allowance on cigarettes and there is
no doubt it is the most important currency in those institutions.
To take away a consumers right to smoke, is to make not only the consumers
unhappy but also the mental health facility a negative place.
The use of tobacco has a calming influence on consumers and therefore
operates as a form of self medication for the consumer.
Generally, to ban smoking in such facilities will result in an escalation in
tension amongst the consumers.
(d) Research Statistics
A report prepared for SANE Australia by Access Economics late last year1
revealed that over 38.3% of smokers have a mental illness. Even more
significantly, the research also revealed that with some types of consumers
such as those with schizophrenia, around 90% smoke.
The report also showed that at least 42% of all cigarettes sold in Australia are
consumed by people with a mental illness.
This research reveals how big an issue smoking is to consumers. It is one
of the few pleasures they control. It preserves and enhances their personal
autonomy and has become a fundamental part of their culture.
(e) Passive Smoking Issues are Manageable
Any problem of service providers and others being exposed to the dangers of
passive smoking can be overcome by setting aside designated smoking areas
within these institutions. That is the current practice in NSW and has worked
well in the past.
(f ) The Experience in other Comparable Jurisdictions
In other jurisdictions including Victoria and England, exemptions from
prohibitions against smoking have been given to mental health institutions.
(g) The Position of the United Nations
The views outlined in this submission are entirely consistent with and are
supported by Principle 9 of the UN resolution 4619 adopted on 17 December
1991 entitled Principles for the protection of persons with mental illness and
the improvement of mental health care.
The opening words of that Principle say, Every patient shall have the right to
be treated in the least restrictive environment and with the least restrictive or
intrusive treatment ..
1 Access Economics (2007) Smoking and Mental Illness: Costs. Report for SANE Australia, December, Canberra
4. A Fair Outcome
Our submission does not advocate smoking. Rather it argues that this
particularly vulnerable section of society should not be targeted with bans
that the government will not impose on the larger community. As we
mentioned, such a ban would not only be undemocratic, but also impose a
disproportionate level of suffering on those who are already suffering enough.
It is our submission that the Taskforce refuse to recommend the banning of
smoking in mental institutions. Instead we ask that the Taskforce recommend
that as an addition to the mental health treatment programs available to
consumers, add on smoking intervention programs be made available to
consumers who smoke encouraging them to give up smoking through
treatment programs such as self-help groups, support phone lines, access to
quit phone lines, appropriate education materials and the use of such tools as
nicorettes or patches.