LYNN NEARY, host:
Smoking bans have also reached psychiatric institutions. Studies have shown that people with mental illness are twice as likely to smoke as others. And as recently as last year, a survey reported that 59 percent of U.S. psychiatric hospitals still allowed patients to smoke. But now many state psychiatric hospitals are prohibiting smoking.
NPR's Alix Spiegel reports.
ALIX SPIEGEL: Patrick Canavan started to his job as CEO of St. Elizabeth's psychiatric hospital on January 2nd of this year. And on January 4th he called a meeting with his staff. After 150 years, he explained, St. Elizabeth was going cigarette-free. Patients would no longer be permitted to smoke anywhere on its sprawling campus.
Canavan says that while a portion of the people in the room welcomed this announcement, most responded this way...
Dr. PATRICK CANAVAN (CEO, St. Elizabeth's Psychiatric Hospital): You've got to be kidding. What is wrong with you? You must be out of your mind.
SPIEGEL: You see, for decades cigarettes have been used to control patient behavior. That's true not only at St. Elizabeth's, but at the vast majority of psychiatric institutions. If patients act out, cigarette privileges are denied. If they calm down, they get a smoke. That's one reason, Canavan says, the staff said that they were worried.
Dr. CANAVAN: You know, we're going to have more instances of aggressive behavior. We're not going to be able to help people, you know, calm themselves down. You know, what are we going to do during smoke breaks? A real worry. You know, fifteen minutes out of every hour was dedicated to smoking.
SPIEGEL: But it was more than that. Canavan says that some of his staff argued that it just wasn't fair to the patients to take their cigarettes away.
Dr. CANAVAN: People who are mentally ill have so few things in life that are enjoyable to them. They don't have significant relationships; they may not have a home; they don't have meaningful work. And if this is one thing that gives somebody pleasure, why would you ever consider taking that away?
SPIEGEL: And what about the patients - many of whom had been smoking for 20, 30 years - how did they feel?
Dr. CANAVAN: Some are angry. Some were worried. One patient who is notably worried said to me, send me back to Max because the only way I'm going to quit smoking is if I have no cigarettes available to me.
SPIEGEL: So who you think you had more trouble from, the staff or the patient?
Dr. CANAVAN: I think initially staff.
Dr. BETH GOUSE (Psychologist): I thought it was going to be really hard.
SPIEGEL: This is Beth Gouse, a psychologist at St. E's for 14 years. Gouse, like the rest of the staff, knew how much of patient life at St. E's centered around smoking and so was worried about what would happen when cigarettes were taken away. But then, she says, she saw how St. E's went about getting patients to quit.
Week by week, cigarette breaks were reduced. There were smoking-cessation programs, patches, pills, gum - a lot of support. So two months ago, when the first totally smoke-free day arrived, it was actually okay.
Dr. GOUSE: It's ended up being not as difficult as we all thought it was going to be.
SPIEGEL: Many people at St. Elizabeth said the same. Now, let's be clear. It's not the case that no patients at St. E's smoke anymore. Some of them go home on weekends and smoke there. Some have privileges, which means they are allowed to leave the campus for a while in the afternoon; they'll smoke then.
But, Canavan says, 100 percent of the patients at St. E's have, at a minimum, cut down. And some have stopped altogether. Since mentally ill people die, on average, 20 years earlier than non-mentally ill people, and since smoking is part of the reason, Canavan thinks the smoking bans he and others are beginning to implement are a good thing. But one of the largest mental health advocacy organizations in the country disagrees with him.
Mr. RON HONBERG (Legal Director, National Alliance on Mental Illness): At this point in time, we have no confidence that smoking bans are going to serve the best interest of patients, and we can't support those at this point.
SPIEGEL: Ron Honberg is a spokesman for the National Alliance on Mental Illness, a mental health organization which has more than 1,000 affiliates in the United States.
Honberg says his organization supports the idea that mentally ill people, like everyone else, should stop smoking. But, he says, the mentally ill go to psychiatric institutions at their most vulnerable point, and to force them to quit when they're in such crisis is just wrong.
Mr. HONBERG: We are worried it's going to make people sicker. It's going to make recovery that much more difficult. And there are many people with mental illnesses around the country who similarly articulate those concerns.
SPIEGEL: Part of the fear then, Honberg explains, is that if institutions do go smoke-free, mentally ill people will no longer be open to getting institutional help. He talks about a woman he met a couple of years ago whose husband was schizophrenic and who said she would love for him to quit.
Mr. HONBERG: But she also knew that if, in fact, her husband was aware that treatment programs did not allow smoking, he would never seek treatment.
SPIEGEL: But maybe patients don't have as much to fear as they think. One afternoon last week, across the street from the front gates of St. Elizabeth's, a small crowd of patients gathered off-campus to smoke a few cigarettes during their short afternoon break. A woman named Juliette explains that despite the ban, patients still secretly smoke on campus - in bathrooms, and out of the way halls, behind buildings. Every ward, she says, has at least one cigarette dealer.
JULIETTE (Patient): One lady sneaks them in in her hair. She gets a braid, and then puffs it up on the top and sticks cigarettes in it.
SPIEGEL: Juliette says at first she hated the idea of the ban, but she thinks it's gone much better than she expected.
JULIETTE: Actually, most people have taken it very well. I mean, everyone's kept their cool, for the most part.
SPIEGEL: So do you think that the smoke-free thing has been a success?
JULIETTE: For the most part. For the most part. I mean, I think these patients are a little more responsible than anyone gave them credit for.
SPIEGEL: As for CEO Patrick Canavan, he has no doubt that the smoking ban is good and that the smoking ban is working. He said he knew it was going to fly a couple of weeks after the ban went total, when he ran into an old friend at the end of the day.
Dr. CANAVAN: Yeah, there's this one particular nursing staff who I have known since I was a little psychologist, a baby psychologist here at St. E's, and she's tough, and she tells it like she sees it all the time. And she said to me one day, you know, baby, you might be right, just that much as she's walking out of the building. You might be right. That was it. And I thought, if I got her, if she's willing to give me that much, I thought, we're going to be okay.
SPIEGEL: Alix Spiegel, NPR News.
NEARY: And you can get the latest recommendations on a range of health topics, from preventing infections to getting vaccinations at npr.org/yourhealth.
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