To the Editor: In a letter to the editor in the March issue, Kenneth Marcus (1) opines that banning smoking in state psychiatric hospitals poses "a dilemma when applied coercively to a class of patients whose lengths of stay are indeterminate." He argues that the state hospital is home to those patients and that no government body has passed measures regulating smoking in persons' homes. He asks, "[W]hy is it that I can smoke in my home, you can smoke in your home, but long-term residents of psychiatric institutions cannot smoke in their homes?"
If our goal as psychiatrists is to promote all aspects of our patients' health, why should we not preventively treat the DSM-IV disorder of nicotine dependence in our treatment facilities? If Dr. Marcus' main concern is for patients' civil liberties, is he prepared to argue that drinking alcohol should be allowed in psychiatric hospitals? After all, alcohol is also a legal substance that is unregulated in the home. The question would then become, "Why is it that I can drink in my home, you can drink in your home, but long-term residents of psychiatric institutions cannot drink in their homes?"
Also, many states and countries have regulated smoking in the workplace because of the harm that second-hand smoke inflicts on employees. Should employees of psychiatric hospitals be subjected to unnecessary harm?
Finally, it's fairly self-evident that patients' physical well-being would be improved by banning smoking, but it can also be argued that their long-term emotional well-being would improve when they learned that they could function well and enjoy their improved physical health without being enslaved to an addiction.
Dr. Chisholm is in private psychiatric practice in Atascadero, California.
Marcus K: Smoking bans in long-term inpatient settings: a dilemma. Psychiatric Services 59:330, 2008