Addressing Symptoms

Cigarettes and Tobacco Use in Mental Health Settings

The growing trend in most mental health centers is the banning of tobacco products and their use on campuses that deliver treatment and other supportive programs. When I first entered the mental health system, I was in-patient in an adolescent unit in New York State. Within a year of the time I landed in the hospital, smoking was banned for adolescents with privileges allowing them in the courtyard and outdoor areas. The rationale, I was told at the time, since minors weren’t allowed to purchase cigarettes they shouldn’t be smoking. This I accepted with a giant grain of salt.

However, by the time I was hospitalized in the New York State Psychiatric Center in upstate New York a mere five years later, smoking was banned for all patients, staff, and visitors on the campus of the hospital. This I took issue with as a patient whom was so dysregulated and uncomfortable from new active symptoms requiring the simple and pleasurable relief from tobacco. What I mean here is that when a person is so far from baseline that all previously learned coping skills don’t work anymore, why deny people use of their existing mechanisms for finding relief in the most difficult moments of perhaps their life?

I understand the need and move to ban tobacco use in community health settings. Sure, teach people with access to community resources, and their private spaces, too use new and diverse skills beyond the scope that tobacco can offer its users. But, in the hospital, where people are locked away from their homes and private spaces, allow people some sort of familiar device to access when everything else is inaccessible or prohibited on the unit.

People at the out-patient level are more likely to be able to use other coping mechanisms for finding relief from mental health systems, this has been researched. However, still requiring research is the threshold, that space where the risks of smoking outweigh the benefits of non-smoking and wearing a nicotine patch until that too is ultimately discontinued. Indeed, even the patch will be discontinued after people are supposedly no longer physically addicted to nicotine due to the time that elapsed between their last cigarette and use of the patch.

In my opinion, this new shift in so-called healthier practices and wellness overlooks a part of human nature, personal freedom, and basic psychology. There are some people with cognitive deficits and symptoms which are so intense that learning new skills will not outpace the cravings or pleasure derived from puffing on a cigarette. These people will not learn new coping skills fast enough to gain the benefits of not smoking and will be even more uncomfortable and agitated during a tremendously already agitating point in their mental health.

In a time where people are pushing freedom and personal choice in treatment, I am truly shocked the hospitals were so fast to embrace the smoking ban. I have been so sick that I wouldn’t get out of bed for days at a time. It wasn’t a pill or the promise of deep breathing that motivated me to get out of bed it was a cigarette and coffee. When a person is truly symptomatic, in terms of coping skills, it is truly about going back to the basics, and clinging to what works, what you know, and what you feel will make you feel better in the moment. I truly hope the hospitals discontinue this movement and revert back, at least in part, to an earlier time when life’s pleasures weren’t incorporated into their treatment without consent or choice.

Be sure to watch this classic scene from One Flew Over the Cuckoos Nest which highlights my points in cinematic proportions detailing what really is at stake when someone is in crisis and needs to calm down or be subject to restraint or in today’s terminology risk of seclusion and isolation from the unit.

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