Canada’s largest mental-health centre is on the cutting edge of research in the field of mental illness and addiction research. But this summer, it’s embarking on a whole new kind of experiment.
Starting in July, staff and patients at the three main sites of the Centre for Addiction and Mental Health in Toronto will no longer be permitted to smoke on the property – a change that is likely to be a major source of conflict.
Mental-health patients have much higher smoking rates than the general population, as well as a psychological dependence on cigarettes that can make quitting particularly difficult. And because smoking can be a comfort, policy-makers and members of the mental-health community have been reluctant to adopt strict bans.
“The mental-health system in many ways has supported tobacco use among clients for a number of years,” said Joy Johnson, professor of nursing at the University of British Columbia who studies nicotine dependence. “We’ve been very quick to offer cardiac patients smoking cessation, but not as quick to offer patients with mental illness smoking cessation, so it’s a bit of a double standard.”
Experts say smoking is a serious health risk to patients and that restrictive bans are a necessary – and long-overdue – change to the culture of complacency that has traditionally defined smoking policies in mental-health centres.
But such restrictions have become a highly sensitive issue in recent years as a growing number of public and private institutions adopted smoking bans. In 2006, Whitby’s Ontario Shores Centre for Mental Health Sciences sparked anger among patients and neighbouring residents when it banned smoking anywhere on its grounds.
The majority of mental-health facilities now enforce indoor smoking bans, but allow patients and staff to smoke a few metres outside hospital entrances.
That is all about to change at CAMH. And because it is the country’s largest mental-health centre, other institutions will undoubtedly be watching to see how the new policy unfolds.
Tony George, clinical director of the schizophrenia program and chair in addiction psychiatry at CAMH, said when he first got started in the field, colleagues warned him that touching the issue would kill his career. Now, he’s decided to push forward with an all-out ban because he believes the health of patients is at stake.
“This may be the leading killer of people with mental illness,” Dr. George said. “In mental health, we’ve probably been a little more forgiving because our patients have a higher rate of smoking and more difficulty quitting, but, unfortunately, it’s probably one of the leading reasons that our patients die.”
Those health concerns will likely have to compete with arguments from patients who say the new policy infringes on their rights.. Anyone who wants a puff will have to head to the sidewalk, even at night or in the dead of winter. It’s an added inconvenience because CAMH’s grounds are fairly large and border sidewalks that tend to have high pedestrian traffic. It also means a disruption to routine, often an important coping mechanism.
One former CAMH patient said the ban seems unnecessarily prohibitive and will likely fuel anxiety among patients. Julie, who was treated for depression at CAMH last year and asked that her last name not be used for privacy reasons, said many patients use smoking to calm down.
“Now you’re adding a whole other level of stress,” she said.
Those arguments help explain why other mental-health centres have held back on broader smoking bans. For instance, at the Royal Ottawa Health Care Group, patients can smoke in designated areas on the hospital’s property. Margaret Tansey, vice-president of professional practice and chief nursing executive, said she would like to see the centre go completely smoke-free, but it’s not a simple issue.
“I think we do understand that for those with major mental illnesses, smoking does give them a sense of relief,” she said. “In a sense, you’re taking away … something they see some benefit in.”
At CAMH, Dr. George said he has no illusions about the negative reaction the expanded smoking ban is likely to create.
“We’ve already seen some resistance,” he said. “I think the biggest anxiety is among the staff and administration. They think all heck is going to break loose, patients are going to be aggressive, fighting, there’s going to be surreptitious smoking on units.”
Dr. George said research has shown the major bumps pass after a few months, and that a complete smoking ban can actually calm patients. He added that since staff at mental-health centres also have high smoking rates, they will be encouraged to quit once the new rules take effect.