Arizona psychiatric hospital bans smoking

From The Arizona Republic:

As smoking was banned in more public places over the past decade, one of the state's most vulnerable populations was permitted to puff away: psychiatric patients at the Arizona State Hospital.

Exempted from ever-widening smoking bans, the hospital practically encouraged people with serious mental illnesses who live at the hospital to smoke. Up to 20 cigarette breaks a day were written into some patients' daily schedules.

That changed on July 1 when the entire campus of the hospital on Van Buren Street went tobacco-free. Residents, staff, visitors, vendors and all others who set foot on the Phoenix property are forbidden from lighting up.

John C. Cooper, chief executive officer of the hospital, launched the effort a year ago after consulting with the hospital's managers. He was responding to a shocking report released in 2006 detailing the death rates of psychiatric patients in public facilities.

"It said that our people die 25 years before people who don't receive our services, and the reasons were all smoking-related," he says. "It was shocking. We're a health-care agency, and we were doing things that are not healthy."

The group that released the report, the National Association of State Mental Health Program Directors, also reported that about 60 percent of public mental-health facilities allow smoking.

There are several reasons smoking has lingered. One of the main ones is the sentiment long held by even doctors that smoking is one of the few pleasures left to troubled patients.

"I've done nothing in my career except psychiatry, and we've been hesitant to go there with our patients," Cooper says. "Some felt, 'These poor things. This is the only thing they have left.' "

Psychiatric patients have much higher rates of smoking than the general population, about 75 percent compared with 22 percent, according to the mental-health directors' group. But Cooper says that in some units of the state hospital, smoking rates approach 100 percent.

"One thing that would just break my heart was when people would say to me, 'I didn't smoke until I got here, and there was nothing else to do during the time when everyone was out there smoking,' " he says.

The Arizona State Hospital serves about 300 people who have serious mental illnesses, including those who must live there because they are a danger to themselves or others and those who are sent there by the courts. Other mental-health facilities in the state - and even the jails - are smoke-free.

Another reason for the delay in the ban is that the hospital is essentially the residents' home, and regulating behavior at home is a tricky issue, according to Anand Pandya, a psychiatrist and president of the board of directors of the National Alliance on Mental Illness, a patients advocacy group.

"There was concern that going smoke-free may discourage people from getting psychiatric treatment and also concern that for people who have very limited rights within the facility, this is a thing they choose to do and, if they're there for a long period of time, that they are being deprived of something that other people have as a right," says Pandya, who is also director of inpatient psychiatry at Cedars-Sinai Medical Center in Los Angeles.

In fact, the Arizona Health Department's own Office of Human Rights opposed the ban when it was announced last year, believing it violates the patients' rights. The office encourages a voluntary cessation program instead.

However, Pandya says research has shown that psychiatric facilities become safer when they go smoke-free. The British Medical Journal reported in July that incidents of aggression were cut in half in the year after a smoking ban was instituted at one mental hospital in England in 2006.

Some psychiatric facilities have met resistance when they tried to ban smoking. The Connecticut Valley Hospital's smoking ban has been delayed over a lawsuit filed by residents last October. A ban on smoking outdoors at New Jersey state psychiatric hospitals was signed into law a few months ago over strong objections by patients.