As the Redhead Full of Steam covers brilliantly as ever, there is outrage afoot. And quite right too. Some months ago Professor Kevin Fenton, head of Public Health England, posted a blog about “achieving smoke-free mental health facilities”. He was rightly lampooned on social media for this ill-thought-out attempt to force cessation upon the easiest of targets – those who are incarcerated in state institutions, either voluntarily or against their will.
I have worked at Alzheimers’ institutions. It’s tough. I have not worked in a mental health facility, but I can only imagine how much tougher, more frustrating, potentially dangerous and above all thankless the staff’s task must be. To offer the care required involves patience, mental & sometimes physical strength, levels of understanding and people skills that many of us simply couldn’t envisage, and a whole lot of support. To do this job with a whole bunch of people that are told on arrival that they can no longer smoke or vape is simply making things more difficult than they already are for everyone involved.
Professor Fenton is adamant, however. He states:
Many people believe that smoking helps relieve stress and anxiety, however the opposite is true.
Really Kevin? Are you absolutely sure you have a sufficient understanding of smoking and mental health to make such a bold statement? The conclusion of the study he links to is striking:
Whether or not smoking cessation directly causes the observed improvement in mental health, there are direct clinical implications. Smokers can be reassured that stopping smoking is associated with mental health benefits. This could also overcome barriers that clinicians have toward intervening with smokers with mental health problems. Furthermore, challenging the widely held assumption that smoking has mental health benefits could motivate smokers to stop.
“Whether or not”? – fucking hell, how un-scientific can you get? Isn’t it likely that those clinicians mentioned have erected those barriers for a precise and well-understood reason? That they understand the implications and potential dangers of enforcing a puritan mindset on a group of people who are likely to be the most seriously and dangerously affected by rigid prohibition.
What seems to be missing here is a whole lotta understanding of smokers, smoking and behavioural science in general. It’s one thing to say “Yes, I’d like to quit. I’ll do just that. Hooray! Now I’ve quit, I feel better.” It’s another thing entirely to say to someone “Welcome! You will be staying here, under lock & key. No, you can’t smoke. It’s a no-smoking facility. Yes of course you can go outside. No, you can*t smoke there either. Oh you’re a vaper? Why didn’t you say? No, that’s not allowed either. Why? Because Glantz. And Fenton. And McKee. Yes, I hear you, they’re fucking idiots who are twisting science and lying to fit their agenda. But rules is rules I’m afraid.”
Oppressor Fenton continues:
“Ultimately our efforts in this area will be rewarded by a reduction the rates of smoking among people with a mental health problem in England. It is part of PHE’s wider work with partners to significantly improve the physical health of people who live with a mental health problem.”
We will shortly publish commissioning guidance for secure mental health settings to go smokefree, helping us achieve our ultimate goal of all mental health care delivered in an environment free of smoke.
Is it just me or does this seem like the predictable target-chasing of anti-smoking, anti-vaping fanatics, rather than a genuine attempt to deliver the kind of modern mental health care that I’m sure most of the public, as well as the more understanding and pragmatic of staff, would prefer were offered?
It’s not the first time we’ve seen public despair as an unaccountable Fenton runs out of control, chasing down some of the most vulnerable amongst us. Hopefully it will be the last. Mental health facilities are for dealing with mental health Professor Fenton. Take your enforced cessation policy and your anti-smoking, anti-vaping puritanism and lock it away in a secure unit please – it is not welcome, nor is it safe to be allowed to roam free in our society.