Sir: Hamid Ghodse’s excellent editorial in the January 2007 issue of International Psychiatry omitted one aspect of the smoking disease in mental health services – the political. On a global scale, it is clear that the tobacco multinationals must recruit very large numbers of new smokers each year. This they do increasingly by targeting low- and middle-income countries, and, within these countries, especially the young and the poor.
In the West, smoking is now a marker for poverty and most psychiatric patients are poor. So also are their care staff, particularly untrained nurses, who are some of the lowest-paid workers in Western society.
Smoking has become not only a class identifier of the dispossessed, but, however much we hate to admit it, a valued habit of poor workers, whose threatened loss causes alarm and resentment. None the less, it is an ethical imperative to stamp out smoking. To fail in this is to collude with the exploitation of poor patients and staff, as well as to fail our medical duty. To cite ‘human rights’ as a reason for retaining the truly squalid ‘smoking rooms’ in hospitals is legally incorrect. Article 2 of the European Convention prohibits the taking of human life and consequently the promotion of any activity that risks it. Article 3, which relates to inhuman or degrading treatment, may also be invoked. These are both absolute directives, and both they and our own Hippocratic command from antiquity to do no harm outweigh Article 8, the right to private and family life, which is broadly defined and not absolute, but conditional upon, among others, measures for ‘public health’.
The political aspects must therefore be understood. The fight against smoking has to be on a global as well as on a local front. The multinationals must be confronted. The exploitation of health workers must be addressed and fair wages paid. Closing the smoking rooms is another step in normalising psychiatric patients and reducing stigma as well as improving health. The sensibilities of the staff who interact most directly with patients, and whose input is grossly underestimated, namely untrained nurses, must be understood. Smoking is a means by which we are all potentially exploited by large capitalist enterprises.
Incidentally, a physician colleague used to confess his wonderment to me that psychiatrists continued to treat schizophrenia by the use of ‘kippering rooms’.
Dr R. L. Symonds MB ChB FRCPsych LLM
Consultant Psychiatrist, Medical Member, Mental Health Review Tribunals; ‘Wynstow’, 12 North Foreland Road, Broadstairs, Kent CT10 3NN, UK, email r.l.symonds@dsl.pipex.com