CAMH to go smoke-free

TORONTO – Canada’s largest mental-health hospital is planning to be smoke-free by July – but one patient-advocacy group cautioned Tuesday that a total ban will only succeed if supports are in place to help mentally ill patients deal with nicotine-withdrawal symptoms.

"If you’re going to have no smoking anywhere, you have to help people with a smoking-cessation program," said Chris Summerville, CEO of the Schizophrenia Society of Canada. "It’s going to be tougher for mentally ill patients to quit smoking because nicotine has a more sedative effect on them than it does on you and me."

The Centre for Addiction and Mental Health (CAMH) already bans smoking indoors, but starting on July 1, it will also prohibit patients and staff from lighting up anywhere on its downtown Toronto property.

According to the centre, 75 to 90 per cent of people with psychiatric disorders use tobacco.

A recent report by the Canadian Centre on Substance Abuse found that those suffering from schizophrenia were two to three times (55 to 88 per cent) more likely to smoke than the general population. Those with alcohol dependency were also found to be more likely to be addicted to nicotine.

"This is not about taking people’s rights away or forcing people to quit. It’s about creating a supportive environment," said Dr. Peter Selby, the clinical director of the addictions program at CAMH.

"We have to step up to the plate."

The rate of death among the mentally ill from smoking-related illnesses – like diabetes and cardiovascular disease – are substantially higher than the general population, and according to some research, schizophrenia patients who smoke on average die 20 years sooner than non-smokers.

Selby said the decision to go completely smoke-free has been 10 years in the making, and will include medication and counselling to help those who want to quit.

"We really need to create a culture of transformation," he said. "There’s hypocrisy in the fact that people can still smoke at a hospital, an addiction facility."

But the real effect of this ban will arguably be a change in how society views smoking and the mentally ill.

When the Smoke-free Ontario Act came into effect in 2006, it exempted psychiatric hospitals from banning smoking in public areas because there were fears that aggression rates among patients would increase. While all have prohibited puffing up inside their facilities, some have not taken the next step of prohibiting it on their grounds.

In 2003, the Mental Health Centre Penetanguishene – a 312-bed facility near Barrie, Ont. – was the first in the province to prohibit smoking on its property.

At that time, psychiatrist-in-chief Dr. Russel Fleming said there was a lot of backlash from staff and the community over fears that it would cause rioting among patients who were heavy smokers.

Those fears never materialized.

"People were saying, ‘It’s going to be mayhem if you take smoking away,’ " he said. "They thought there were going to be higher rates of assault, or people wouldn’t come to the hospital anymore because they couldn’t smoke. The fact is that didn’t happen."

Fleming said smoking frequency has gone down at the hospital, but admits that many patients still smoke when they go off the property on day-trips.

"Patients still find it very difficult, even if they’re motivated, to quit. Some have reduced the number of cigarettes they smoke from a pack-and-a-half a day to only seven to 10 cigarettes," he said. "It was still a step in the right direction and a battle worth fighting."

The Ontario Shores Centre for Mental Health Sciences, in Whitby, Ont., which also faced public backlash when it put in place a smoking ban three years ago, reports the same success.

"The reasoning behind the decision was that persons with mental-health issues need the best physical health in addition to the best mental health," said Dr. Philip Klassen, the centre’s vice-president of medical services. "We need to lead and model for these patients."