In this article...

• The background
• The Rampton experience
• The decision
• What does this mean?

The background

When the Government first embarked on a consultation in relation to the proposed smoking regulations, its proposals were similar to those for prisons and hotels – that is, that they should be exempt. However, the proposals proved to be very controversial among many healthcare professionals. Of the respondents to the part of the Government consultation dealing with the issue of mental health, approximately 65% thought that there should be no exemption or a time limited exemption granted for mental health units, as opposed to approximately 20% who did not. The government decided to impose a smoking ban in workplaces, public places and enclosed parts of non-residential mental health units from July 2007. A year long time limited exemption (a so-called "sunset clause") was imposed for residential mental health units. From 1 July 2008 this time limited exemption will end and from that date smoking will be against the law in any enclosed or substantially enclosed part of any mental health establishment.

The Rampton experience

A smoke free policy was introduced in Rampton with effect from 31 March 2007. The court heard evidence from the hospital that the consequence of this policy had been as follows:-

		There had been no increase in the prescription of sedative drugs.
		There had been fewer problems and medication related to asthma and respiratory matters.
		There had been a reduction in manipulative behaviour associated with cigarettes, such as bribery, exploitation and bullying of vulnerable patients.
		There had been no evidence that nicotine withdrawal has led to behavioural disturbance.

These conclusions are largely mirrored by international studies examining smoke free policies in mental health units.

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The decision

Lord Justice Pill and Mr Justice Silber dismissed the claims and held that :-

		Preventing a person from smoking does not sufficiently effect a person’s moral integrity or identity such that it was incompatible with Article 8 ECHR.
		There is a distinction between a hospital where a patient is detained and a prison. Health and security reasons justify the ban, even though smoking in the grounds, which may be possible at other hospitals is not feasible at Rampton. There is no incompatibility with Article 14 ECHR
		Inserting the meaning "except in mental health units where it is not feasible to permit patients to smoke outdoors" into Regulation 10(3) of the Smoke-free (Exemptions & Vehicles) Regulations 2007 would require the court to perform a legislative act and the exemption was clearly intended by the Secretary of State to be temporary. There is no general right for psychiatric patients to smoke.
		The ban at Rampton had not been applied in an unlawfully inflexible manner.

What does this mean?

		From 1 July 2008 smoking will be against the law in any enclosed or substantially enclosed part of any mental health establishment.
		Consistent and ongoing enforcement is necessary and the attitude of staff is crucial.
		In general, units should ensure that they display no smoking signage on the premises, and have a clear and simple smoke-free policy communicated to all members of staff, service users and visitors.
		Units should provide education about the health effects of smoking and provide advice and support on quitting for both staff and service users.
		Mental health professionals should be trained in smoking cessation.
		The physical environment should be assessed and attempts made to provide pleasant leisure activities as alternatives to smoking.