Scottish Government Defies Public Opinion

Written answers from the Cabinet Secretary for Health and Well-being on 30 September
By: Freedom To Choose (Scotland)
Oct. 9, 2010 - PRLog -- Written answers from the Cabinet Secretary for Health and Well-being on 30 September reveal that the Scottish Government plans to introduce ‘guidance’ that ‘would help mental health residential service providers move towards smoke-free environments’.(1)

Producing guidance was the least popular of the three options offered in last year’s consultation on smoke-free mental health services: most respondents wanted the exemption currently enjoyed by mental health facilities to remain in place. The break-down was as follows: (2)

51 per cent voted for the status quo, keeping the current smoking ban exemption (including 81 per cent of patient groups);
35 per cent voted to amend the legislation (including 63 per cent of NHS groups)
12 per cent voted for the guidance

Not only has the Scottish Government chosen the least popular option, it has also done so with a clear intention to introduce a smoke-free service, the option that was rejected by over 80 per cent of patient groups. Most supporters of smoke-free services were NHS groups (3) – not necessarily those involved in clinical care. Freedom to Choose (Scotland) spokesman Eddie Douthwaite says, “A regime where smokers are forced to stop smoking creates a perceived demand for smoking cessation services, and the issue of competing interests must be considered relevant to any submissions to the consultation from smoking cessation specialists.”

Exemptions in the original act were included because, in the words of then Health Minister Andy Kerr, “because clinicians and others told us that that would be appropriate, if individuals' overall mental health and well-being were to be looked after”. “Residential homes are where people live and have their home. We felt that, as long as there was a smoking policy in such places, people would have the right to smoke where it was deemed to be their home, just as others in the community have that right.” “There were obvious humanitarian and other reasons for that exemption.’’ Eddie Douthwaite asks, simply, “What has changed?” (4)

A specific issue raised by patients during consultation was whether patients would be deterred from seeking treatment if the regime in psychiatric units banned smoking. (5)  A report from Toronto (6)  found precisely this. “Patients were turning up at a walk-in centre and being detained. They wouldn’t stay voluntarily after learning that they would be forced to stop smoking,” said Eddie Douthwaite. “Instead of voluntary admissions you have people being sectioned because of this policy.”

Eddie Douthwaite has a further problem with the answers given by Cabinet Secretary Shona Robison. “Why is she talking about residential service providers?” Early stages of consultations that did not involve the general public found that respondents, while happy to see smoking restricted for acute care patients, felt different when it came to considering long-stay patients for whom the hospital was effectively their home.  (7) “The consultation failed to point out the different circumstances of acute and continuing service users or to admit that these early respondents had reservations about stopping people from smoking in long-stay accommodation. The use of the words residential service providers suggests that they are moving the goal posts yet again. They now want to introduce a policy that goes against the wishes of around half their ‘approved’ stakeholders as well as most of the service users.”

1 Written Answers, Thursday 30 September 2010,
2 Research Shop, Consultation Summary, June 2009,
3 See link to consultation responses for consultation Towards a Smoke-free Mental Health Service,
4 Health Committee meeting 22 March 2005,
5 Research Shop, Consultation Summary, p. 24
6 Smoking Ban at Psychiatric Hospital Linked to Increase in Involuntary Admissions,
7 Paras 3.1.1. and 3.1.2, Moving towards smoke-free mental health services in Scotland, April 2007, McNeill, Bauld and Ferguson

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