I'm afraid I have some experience of this as we recently enforced a no-smoking policy across the area in all health care facilities.
Now don't get me wrong I understand the reasoning behind non-smoking policies, both for the health of staff and that of clients, however I do believe mental health settings have an arguement to be considered different.
Firstly the ethical issue, we often lock people up in hospital due to mental illness, they do not have a choice in the matter. To then impose our standards on patient regardless of history (eg having smoked for decades with no intention of stopping) smacks of big brother and we are supposed to be advocating for greater autonomy and inclusivness in mental health care for patients.
Secondly, how do you think your attempts to form a theraputic relationship with someone is going to go when you have deliberately denied a drug of addiction, that outside of the hospital grounds is a legal entity.
Thirdly I dont know about other areas, but here, staff have been told that they cannot visit the home of a patient in the community unless that person has agreed to not smoke while staff are present.... even if they are on a Community Treatment Order (compulsory MH care in the community). Now imagine the not unlikely scenario where a CTO client (who does not want our care or treatment) refuses not to smoke when staff are present... are we really going to breach that person and force them into hospital because they wont stop smoking?? The 'educator' who came to explain the policy to us had a real hard time with that one.
How many PRN's/sedation/restraint actions are going to occur as a result of patient agitation due to lack of access to 'smokes'. Well as I said I have some experience via the local staff in the Acute Unit, the answer is many many incidents. None of which can be attributed to anything other than the smoking policy. The Area managment seem to have adopted a wonderful strategy in order to implement this and keep the State Health service happy. Staff initially religiously reported incidents via the online incident system.
However over a course of weeks and months staff simply stopped reporting as there was absolutely no action taken by management to reduce the level of incidents or review the policy. This pattern was perfect to evidence to State Health that while there were some inital problems, things seem to have settled down
(using the reporting stats).
All I can say, is please think very, very, carefully about implementing such blanket policies into health care, especially MH facilities. Patients who smoke do so often for a theraputic reason associated with their illness, it may not be the healthiest or best strategy, but who the hell are we to tell people how to live their lives on something like smoking, when we have forced them into the facility in the first place.
I would hope that even non-mental health workers can see the potential for violence that this can lead to, and which is a reality in this area.