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Psych Wards No Longer Support Smoking

Smoking has long been used to reward and even help medicate mentally ill patients.

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By McCarton Ackerman

02/07/13

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For decades, mental hospitals have allowed—or even encouraged—their patients to smoke, but no longer, the New York Times reports. Until recently, Louisiana law required mental health programs to accommodate smokers. “It’s mandatory to smoke,” said Annelle S., 64, a patient with paranoid schizophrenia at Southeast Louisiana Hospital. “It’s a mental institution, and we have to smoke by law.” But this was 18 months ago—and the law has since changed. A survey issued in 2012 by the State Mental Health Program Directors association found that nearly 80% of state hospitals are now smoke-free; and by the end of March, smoking will end in Louisiana's two remaining state psychiatric hospitals. The ban may be hard to enforce. The smoking rate among mentally ill adults in the US is 70% higher than in those without mental illness, according to new data from the Centers for Disease Control and Prevention; despite making up just one-fifth of the adult population, they consume one-third of the cigarettes in the US. A report by the National Association of State Mental Health Program Directors suggests that people with the most serious mental illnesses have a lifespan about 25 years shorter than the general population, often due to smoking-related conditions like heart and lung disease.

Still, many family members and advocates of people with mental illness endorse smoking for the relief it can provide, despite its health detriments. And some hospitals still use cigarettes as incentives or rewards for taking medicine, following rules or attending therapy. Dr. Nora D. Volkow, director of the National Institute on Drug Abuse, says smoking can have antidepressant effects—and for those with schizophrenia, it can help reduce extraneous thoughts and voices. Smoking is also found to facilitate the effects of certain medications; in some cases, it may be more effective than the medication itself. “Whenever he runs out of cigarettes he becomes highly agitated to the point where he has seriously injured staff and other patients," wrote Dr. Elizabeth Roberson in 2000, then a psychiatrist at Hawaii State Hospital, while describing one of her patients. “Providing a cigarette is generally much more effective at decreasing agitation than most medications I can provide.”

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