[Bjo]

OUr hospital has been non-smoking inside the facility for a long time. Starting in July, the patients will no longer be able to go outside to smoke. That means that for the last several months, they have been limiting the amount of cigarettes the patients can smoke.
Once the patients earn levels, they can go outside on privileges and they take their cigarettes with them. Depending on the restriction of the level, they can be outside quite a few times during the day.
My question is, does anyone have experience with long term forensic patients being forced to quit smoking altogether? I have read several articles that it can affect the levels of the psychotropic medication as well as trigger a depressive setback.
Any feedback would be greatly appreciated. I am on a recovery awareness committee and I am trying to come up with some information to take with me to the next meeting.
The patients have wanted to file grievances with the patient advocate but he has told them that smoking is not a right that they can grieve.

[z's playa]

Be prepared for chaos is all I can say. My BF works as a security guard in a hospital and can't count the number of code whites once the no smoking policy was enforced.

[Nurse Ratched]

Ours isn't a long term facility, but we have had no problems at all since a no-smoking policy was instituted. In fact, things are much better from staff's standpoint that detoxers don't get their HR's/BP's up artificially for librium purposes, so we can actually get a better handle on where people are in terms of the detox process.

Have had no report of a single code white r/t inability to smoke, and believe me, if it was a problem, the staff who HATE the smoke-free policy would be all over it.

[happthearts]

OK I am one for this ban and I used to be a smoker .We had a geri mental health PT who was alowed to go out side and smoke .The staff is suspose to light the one smoke and the Pt is not to have contact with matches or more than one smoke. Well that Pt came in from outside , it was about bed time so she went right to bed when i started doing 15 min rounds. I kept getting a smell of smoke right at the end of the hall .I kept searching and searching I searched all the halls and upstairs .The charge just said let it go .I didn't

Then I went down the hall again and I smelled smoke strong this time .It was in the PT room in her bed she had lit some of her clothes on fire and placed them at the foot of the bed. I litterally pulled her out of bed pushed her out the door she kept trying to get back in the room The matress was on fire.Had melted almost all the way through .I Took the blankets and started to smother the fire and yelled for help.It was pouring rain out side so the RN and I pulled the materess down to the end of the hall door just off PT room.and let the rain pour on the matress. The fire dept had to come and leave the back door open in the freezing cold Use big fans to get rid of all the smoke .The Pt's were all awake until 4 in the morning .sitting in the day room

Give the patch its safer in mental health.

[Bjo]

I am in favor of banning all smoking, to a certain extent. The main thing is for the forensic patients who have been in this facility for the past twenty or so years and will never leave. This is their home and that makes it a bit different for those people, at least in my opinion. It's kind of like someone telling me I can't smoke in my own home. I can visit non-smoking places and know that when I go back home I can smoke. For these long term patients, they aren't going to be able to smoke EVER. I just wondered if I was being biased thinking that with them it was a little different.
Most of them are on the highest forensic levels that they can earn. They are in the work program, going to town for their GED, etc. Telling them they can't ever smoke again seemed a little punitive.

[TitaniaSidhe]

Bjo you are exactly right in what you are saying about long term patients having the facillity as their home. I work in a VA with many long term patients. I remember when they made the facillities non-smoking, it was pure chaos *sigh* you have to keep in mind that these men & women have some smoked 2-3ppd for the past 30 years & now all of the sudden are told they HAVE to quit. Is it fair for a psychotic patient committed to the facillity by a court of law to be forced to stop his/her perhaps one & only pleasure? Is it their fault they are psychotic? no I think not. Aside from all that, there will be continous problems with smoking & contraband on the unit. It will continue to be smuggled in despite best efforts. Also privileged & higher functioning patients will be sneaking off grounds to purchase cigarettes & selling them for OUTRAGIOUS $$ to the lower functioning patients, essentially taking severe advantage of them. These are but some of my observations of events & happenings since our facillity has gone the total non-smoking route.

[Bjo]

TitaniaSidhe,
We already have trouble with the contraband and the smoking is just limited at this point. The patients go so far as to put pencil lead in the electric sockets to light them because they don't get lighters.
I can really see both sides of the coin, but I think exceptions should be made for the long term patients. I just can't seem to come up with a good enough "speech" to present to admin to advocate for them.

[NurseyBaby'05]

I did some of my clinical rotations at Western Psych and they have specific smoking times that are supervised. The times are posted on plaques on the walls on all of the units/floors. I think they're q2h during from 7a to 11p for 15 minutes. A pt. can smoke more than one cig during this time. Some of them chain smoke for 15 min to tide themselves over until the next smoke time. It's a non-smoking facility as well, but they have enclosed smoke rooms on each unit. It's far from perfect, but it works.

[Bjo]

We have designated times for smoking right now also. But they have to go outside on an enclosed patio and they only are allowed to smoke one cigarette at that time. There hasn't been any smoking inside the facility for several years. My main thing about it is that admin is banning all smoking for the mental health patients. They said it's because it is on state grounds. But if you walk outside the back door of the unit, the mrdd facility is about 15 feet away. That facility isn't banning smoking and they are sitting on the same piece of state ground that our place is. When our patients are outside, after July, and the mrdd patients are smoking away to their hearts content, I can just see the problems looming!

[elkpark]

As a inpatient psych surveyor for my state, I have observed over the last few years as several facilities have gone entirely smoke-free, including the state hospital that was in my territory. The state hospital does not even allow staff to bring smoking materials onto the units with them -- they must keep them locked in their cars and go to the cars on their break time if they wish to smoke.

None of the facilities I visit regularly have had serious ongoing problems related to the change in smoking policy (of course, there was a little flurry of excitement around the time of the change in policy at all these places ... ).

I hear what you're saying about the people for whom the facility is their home, as that is also the case for a lot of people at the state hospital I'm speaking of. That is certainly v. different that being on an acute unit for three or four days.

What the physicians and staff at all these facilities have done is to be v. aggressive about offering nicotine patches and gum, as well as smoking cessation programs in the longer-term settings. None of the management people at any of these places have regretted the change in policy (although I'm sure some individual staff people have!) The doom and gloom predictions by some individuals before the new policies were implemented just didn't happen.

I believe that it is v. important that all the staff recognize that this is a medical/clinical issue (addiction), and be professional about recognizing and addressing the clients' nicotine addiction (with patches and/or gum) rather than just viewing it as a behavioral issue (no longer going out to smoke).