The growing trend in most mental health centers is banning tobacco products and their use on campuses that deliver treatment and other supportive programs.
This trend defies the age-old image of ‘mentally ill’ folks pacing around outside their treatment center or a hospital smoking like chimneys. What is the result and impact of these bans on the folks in my image?
When I first entered the mental health system in 2003, I was an adolescent in an inpatient unit in New York State, and smoking was already banned for adolescents. After all, you would be hard-pressed to find a smoking section in a restaurant anymore. Adults still could smoke, but only in certain restricted areas and at certain times.
Before the banning, adolescents could smoke outside the building when they were granted outdoor privileges, similar to adults. The rationale, staff told me at the time, were minors weren’t allowed to purchase cigarettes in the community. They shouldn’t be smoking in the hospital.
I accepted with a giant grain of salt. After all, I was a smoker, irritable, but appreciative enough of logic in a place and time where reason wasn’t readily available.
However, when 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 hospital campus. At this point in my inpatient career, I drew a line in the sand and took issue.
As an adult in the hospital, I wasn’t just agitated. I was dysregulated, manic, and psychotic. I needed something to self-soothe, and meds and therapy were not cutting it.
Given how bewildered, uncomfortable, and upset I was back from new active schizophrenia symptoms, I couldn’t understand why I wasn’t allowed to smoke cigarettes.
My theory about smoking in the hospital is straightforward. My idea is also within the margins of psychology and elementary logic. When a person is so far from a baseline that all previously learned coping skills don’t work anymore, why deny people the use of their existing mechanisms for finding relief in the most challenging moments of perhaps their life? Why take away the only coping skill that has been working to date? Why must we throw additional barriers in someone’s way to deescalating and finding a moment of peace in a disordered mindset when someone is so sick?
I understand the need and push to ban tobacco use in community health settings. Sure, teach people to access coping skills free of tar, toxins, and health-compromising chemicals. Instead, we need people to learn how to lean on healthier supports and access community resources. In this vein, I am not suggesting pushing cigarette smoking on people who do not already smoke. We certainly cannot allow tobacco companies to come into the hospital and hand out products to vulnerable people and get them addicted to another chemical they will need to manage moving forward discharge.
However, for people with existing habits and already smoke. Why limit, restrict, and agitate these folks further when they could be enjoying a smoke outside like at their own home and maybe feel the impetus to work towards discharge to do just that.
People at the out-patient level are more likely to use other coping mechanisms to find relief instead of smoking or waiting until they get back home at the end of their session or program. 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 is ultimately discontinued, especially for highly disordered, chronic, and comorbid smokers.
In my opinion, this new shift in so-called healthier practices and wellness overlooks a part of human nature, personal freedom, and introductory psychology. Some people with cognitive deficits and symptoms are so intense that learning new skills will not outpace the cravings or pleasure of puffing a cigarette.
These people will not learn new coping skills fast enough to benefit from not smoking and will be even more uncomfortable and agitated during a tremendously already agitating point in their mental health.
When people are pushing freedom and personal choice in treatment, I am genuinely 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 genuinely symptomatic, in terms of coping skills, it is genuinely 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 genuinely hope the hospitals discontinue this movement and revert, at least in part, to an earlier time when life’s pleasures weren’t removed or banned without consent or our choice.