Survey on Impact of Smoking Ban in NSW Health Facilities

NSW Health and Local Heath Districts (LHDs) have adopted the ‘NSW Health Smoke Free Workplace Policy’ aiming to create environments for all visitors, patients and staff free of smoking and Environmental Tobacco Smoke (ETS) at all hospital campuses and sites controlled or funded by NSW Health. Since the commencement of the policy in 1999, each of the Area Health Services (now LHDs) progressed through the phases of implementation of the policy at different rates.

 The policy requires not merely the enforcement of no-smoking within enclosed building spaces, but also requires the removal of all outdoor designated smoking areas on hospital campuses and other Health sites. People wishing to smoke are obliged to leave Health property to do so. With the presence of anti-smoking signs and enforcement of non-smoking protocols, NSW Health aims to provide a clear and consistent message that smoking is a health risk and that staff, patients and visitors should and can quit.

 Smokers, including staff and patients, argue for designated outdoor areas to remain so that they do not have to leave hospital grounds to smoke. However, the policy indicates that individual cigarettes are ‘point sources’ of air pollution and smoking in groups becomes an ‘area source’ according to a report produced by the Cancer Council NSW ‘Smoke and Mirrors:[http://www.cancercouncil.com.au/html/prevention/smoking_tobacco/tacklingtobacco/downloads/Smoke_mirrors_LR.pdf]cites research showing that even outdoor areas produce detectable amounts of ETS. NSWHealth has therefore not been prepared to allow smoking even in open air areas on Health grounds.

 It is easy to see why this policy has been overwhelmingly greeted with praise from the medical community as vulnerable patients should not have to be placed at risk of second-hand smoke at hospitals. It is argued that a ‘culture’ of non-smoking may encourage smokers to quit leading to obvious health benefits not just for the smoker, but for those around them. Additionally, the guidelines state that health services can actively help patients and staff to quit by providing nicotine patches and information for the ‘Quitline’ service. 

 However, concerns have been raised by some people about the potential impact of this ban on the mental health community. Mental health services consumers and facilities had initially been exempted from the implementation of this policy because research indicates that a more significant portion of those with schizophrenia (and some other mental illnesses) smoke than the general community. The commonly quoted statistics are that 80% to 90% of all people with schizophrenia smoke and that 44% of all cigarettes are smoked by people with mental illness.

 The Cancer Council’s ‘Smoke and Mirrors Report’states that these claims are an “exaggeration brought about by misreading’s of the literature”. However, anecdotal evidence from many mental health facilities and carers would seem to support the contention that many people living with mental illness do smoke and that their rates are much higher than for the general population.

 The problem this raises for consumers of mental health services is that unlike other health service users, consumers can be subjected to involuntary treatment and restrictions on their activities which can make it impossible for them to leave hospital premises in order to smoke off Health controlled sites. This means that enforcing a smoke free policy on Health grounds for them means coercively preventing some people from smoking for the duration of their treatment.

 Health’s policy has sought to remedy the effects of mandatory involuntary nicotine detoxification on people by requiring that nicotine replacement therapy in the form of nicotine patches should be routinely made available for smokers undergoing in-patient treatment, especially involuntary treatment, to address withdrawal symptoms.

 However, some have expressed concern at the impact of the imposition of smoking cessation upon consumers with regard to their willingness to seek treatment and on the potential for increased conflict between patients, carers and Health staff as a result of the enforcement of this policy.

 We at ARAFMI are interested in your thoughts and experiences with the smoke-free policies at hospitals and health services. As consumers or carers, have these policies changed the way you, your loved one or your client seeks or experiences treatment?

 We have links to two surveys, one for consumers and one for family, carers and friends of consumers. Each has 13 questions that survey general practices and attitudes towards smoking and the implementation of the ban by mental health services. The collected data will be used to gage how consumers and carers have (if at all) been affected by the smoke-free policy. With enough people filling out the surveys, we hope to present the results to reflect your experiences.

 Smoking in NSW Health Facilities Survey for Consumers”: https://www.surveymonkey.com/s/DQTB56C  

 and “Smoking in NSW Health Facilities Survey for Carers”: https://www.surveymonkey.com/s/DW26J89

 For further reading on the UK experience:

 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2777572/

If you would like to print off a hard copy and post the survey to: ARAFMI at P.O. Box 78/88 William Street WOOLLOOMOOLOO 2011, click on the file link below.