Psych, sex, and cigarettes

[noyesno, MSN, APRN, NP]

I am a nursing student in the last semester of my nursing program and I am currently in my psychiatric rotation at a (locked) long-term inpatient facility with 210 beds. Most patients have schizophrenia, major depression, bipolar disorder, or a combination of a few disorders. Since this is my only experience with this type of environment, I wanted to ask if the following two practices this facility allows are commonplace in most long-term inpatient psych facilities:

1. They can have sex with each other at the facility

The sex concerns me because what happens in the event that a female becomes pregnant. The women here are not capable of taking care of themselves, so, who would take care of the baby?

Another issue with the sex is how can it be assured that people aren't getting taken advantage of. Since these individuals are not thinking clearly at times, can they really consent to sex?

2. They are provided cigarettes by the staff and can smoke INSIDE the building during frequent smoke breaks throughout the day (in the common areas)

The smoking inside is a hazard to everyone in the facility, why would a health care facility agree with this? My instructor keeps saying, "it is their right to smoke." I keep thinking, isn't it the right of the non-smoking residents (doesn't seem to be many of these) and staff (doesn't seem to be many of these either) to have a smoke free environment?

Most of the residents are on Medicaid, why would Medicaid pay for these individuals to smoke? I would understand if they provided them with patches or gum, but cigarettes?

*I should mention I live in a state that does not allow smoking in restaurants or bars. So, it seems really strange to me that a health care facility would be exempt from this law.

Any insight?

Thanks!

[wannabeagreatRN, BSN, RN]

Wow! I am very interested to see if anyone has some insight one this. In all of the psych facilities I have been in, there were strict rules about a male entering a female's room and vice versa.

The smoking inside I also don't know about. Most facilities here do allow smoking privilages but they have a designated outdoor smoking area.

[happy2learn]

I personally wouldn't do a rotation at a place that allowed smoking inside. It may be their right to smoke, but they have no right putting my health at risk when they could easily go outside.

[netglow, ASN, RN]

In my psych clinical rotation it was sex and cigarettes, OK.

Sex: Believe it or not crazy doesn't mean lacking a need for companionship. Staff is aware of "situations". These facilities are home for many.

Cigarettes: You will not be able to withdraw a very mentally ill person from an addiction like smoking without much hardship for that person. Smoking is legal. Again, these facilities are home for many. Some professionals have had a long belief that there is so much their patients cannot do, that they should be able to smoke. This is being questioned fairly recently due to the obvious health reasons. But, since some as you know are voluntary residents, the fear is, if you take this one thing away from what clearly is a very, very hard life... the streets will seem better to many.

It sure does seem way off at first, but if you are just starting your rotation, pay close observation and you will get to know some people and you will understand the misery.

[Altra, BSN, RN]

Most of the residents are on Medicaid, why would Medicaid pay for these individuals to smoke? I would understand if they provided them with patches or gum, but cigarettes?

Medicaid is simply the vehicle which pays for their health care. This does not mean that they don't have funds from other sources for living and personal expenses. (yes, for this patient population it often includes social security or other disability benefits) I'm not disagreeing with your assumption that public funds are ultimately paying for cigarettes - that would be naive - I'm just pointing out that Medicaid is only one piece of the picture.

As far as the intimate relationships between residents ... I have nothing to contribute. My only professional experience is with hospital inpatient behavioral health units - short-term stays usually of 10 days or less - and much more restrictive rules.

[HonestRN]

the mentally ill smoke at about twice the rate of the general population.

Researchers at the Harvard School of Public Health have discovered that Americans with mental illness are nearly twice as likely to smoke cigarettes as people with no mental illness. Their study appeared in the Nov. 22 Journal of the American Medical Association.

The studies implied that smokers used nicotine to treat symptoms of depression, for "mood enhancement," for "anxiety relief," to "cope with stress" and to "gain self-control." The marketing study also suggested that smoking "helps perk you up" and "helps you think out problems."

Why do persons with mental disorders smoke more than others? This study does not really explain. We do know that nicotine is a stimulant, and that it seems to ease the symptoms of some severe disorders such as schizophrenia. 65-90% of persons with schizophrenia are nicotine dependent, probably partly because nicotine relieves some of their symptoms and improves cognitive functioning.

http://mentalhealth.about.com/library/weekly/aa112300a.htm

[Meriwhen, ASN, BSN, MSN, RN]

Neither practice is allowed in my facility. We offer smoking substitutes such as the patch, gum and lozenges...or if they want to quit, they may even get started on Chantix. They used to allow smoking but it became hard to manage the patients and all the requests for smoke breaks so they did away with it.

Sex is also not allowed. IMO, too much of a headache for all (patients and staff) to deal with...especially when a relationship that may have started out as consensual ends up with accusations of rape or abuse because one party's peeved at the other or wasn't capable of fully consenting or whatever.

[itsmejuli]

Off topic: Here's one for ya.

My son suffered a traumatic brain injury. Even when he was oriented x0 he wanted a cigarette and badgered the nurses and everyone else constantly for a smoke.

[noyesno, MSN, APRN, NP]

In my psych clinical rotation it was sex and cigarettes, OK.

Sex: Believe it or not crazy doesn't mean lacking a need for companionship. Staff is aware of "situations". These facilities are home for many.

Cigarettes: You will not be able to withdraw a very mentally ill person from an addiction like smoking without much hardship for that person. Smoking is legal. Again, these facilities are home for many. Some professionals have had a long belief that there is so much their patients cannot do, that they should be able to smoke. This is being questioned fairly recently due to the obvious health reasons. But, since some as you know are voluntary residents, the fear is, if you take this one thing away from what clearly is a very, very hard life... the streets will seem better to many.

It sure does seem way off at first, but if you are just starting your rotation, pay close observation and you will get to know some people and you will understand the misery.

Thanks for your input. :)

I totally agree that everyone needs companionship. My only concern with the sex is pregnancy and consent issues. I'm all for a residents having sex if they are being responsible and consenting to it because I do agree, it is their home.

I suspected there was a reason they weren't encouraging smoking cessation with residents. I do think it is their right to smoke as long as it is not negatively impacting nonsmokers and they are paying for the cigarettes with non-tax payer money.

[noyesno, MSN, APRN, NP]

Medicaid is simply the vehicle which pays for their health care. This does not mean that they don't have funds from other sources for living and personal expenses. (yes, for this patient population it often includes social security or other disability benefits) I'm not disagreeing with your assumption that public funds are ultimately paying for cigarettes - that would be naive - I'm just pointing out that Medicaid is only one piece of the picture.

As far as the intimate relationships between residents ... I have nothing to contribute. My only professional experience is with hospital inpatient behavioral health units - short-term stays usually of 10 days or less - and much more restrictive rules.

I realize I shouldn't have just assumed the cigarettes were all coming from Medicaid. I'm not exactly sure how they pay for them and most likely never will.

[noyesno, MSN, APRN, NP]

the mentally ill smoke at about twice the rate of the general population.

http://mentalhealth.about.com/library/weekly/aa112300a.htm

Thank you for sharing that information. Next week, I will watch and see if I can notice a difference in my assigned resident's mood following a smoke break.

[noyesno, MSN, APRN, NP]

Neither practice is allowed in my facility. We offer smoking substitutes such as the patch, gum and lozenges...or if they want to quit, they may even get started on Chantix. They used to allow smoking but it became hard to manage the patients and all the requests for smoke breaks so they did away with it.

Sex is also not allowed. IMO, too much of a headache for all (patients and staff) to deal with...especially when a relationship that may have started out as consensual ends up with accusations of rape or abuse because one party's peeved at the other or wasn't capable of fully consenting or whatever.

Its very interesting to hear about your facility.

I wonder if the facility I am at offers smoking substitutes to the residents or Chantix. It doesn't seem like they are doing anything but encouraging the smoking.

Good insight on the sex. I agree it could be a source of many headaches for patients and staff.