Smoking in mental health units is in the spotlight at the moment, as a family and community grieve a woman who went AWOL from MidCentral DHB’s Ward 21 after being let out for a cigarette. She died, missing and alone.
When I was first at Te Whare Ahuru at Hutt Hospital as a day ptient in 2004, the octagonal courtyard was assigned as a smoking area for both inpatients and day patients. It was completely enclosed by the building, and it was a safe place for smokers. Fast-forward to 2010, and my short inpatient stay. The courtyard was now smoke-free in accordance with hospital regulations, and smokers had to hid down the side of the building. To get there they had to be let out of the locked ward and trusted to not do a runner.
I remember one day, I was feeling very intense suicidal feelings. I told the nurse, just like I was supposed to, and said that I probably shouldn’t be let out alone. As a result, I was not let out unless there was a nurse available to take me, and I waited a good ten hours for a nurse to come free. It wasn’t intentional – they were just so understaffed. My agitation built and built – the nicotine patch simply didn’t help. The ritual was my addiction – lighting up, inhaling, relaxing.
I spent the rest of the day and into the night highly strung and unable to rest, until they got so sick of me floating around that they gave me a lorazepam at 3am. It was Waitangi day, the 6th of February, and the next day my daughter turned six. I was too out of it to celebrate with her, wrapped in a benzodiazepine haze.
Meandering forward to 2017, I spent three weeks in Te Whetu Tawera, Auckland City Hospital’s mental health ward. The first week, I was first in ICU, where all smoking paraphernalia was banned, and then in Ward A, which had no smoking area. I had no leave. I was trapped, and the nicotine patch wasn’t helping. I needed my ritual. All I wanted to do was sleep to get through my hospitalisation, and it wasn’t til I was given my first escorted leave with nurse that I turned a corner and started looking at living again. That leave was ridiculous – we went straight to the dairy so I could buy cigarettes and get my fix.
Ward B, which I was moved to after twelve days in the unit, had a smoking area. This small mercy made it a much nicer place to be. It meant that I didn’t have to leave the ward and the hospital grounds to smoke – a matter of about 10 metres, but an essential according to the DHB.
I understand the push toward a smokefree New Zealand. I really do. It’s a terrible habit, and it takes 8-10 years off a heavy smoker’s life. On the other hand, serious mental illness takes 10-20 years off the average sufferer’s life, and honestly? We have bigger things to worry about than our smoking habits.
Nicotine withdrawal is the pits, but nicotine isn’t the only chemical in cigarettes – however, it’s the only one dealt to be nicotine replacement therapy. Even with nicotine patches, or gum, or inhalers, or whatever, withdrawals are hell. What I find hard, though, isn’t the chemical addiction. It’s the social and ritualistic addiction that I have built around my habit. Roll, light, inhale, relax. Chat. Socialise. Be a member of a socially unacceptable club.
I know that many people who have a cigarette addiction get incredibly jittery and anxious when they can’t smoke. Why add that pressure to someone already in the terrifying ordeal of a psych ward? Especially someone in the ICU, where everything is so frightening. Zombies all around, demons in your head, and no ritual to banish the fear. Paper-pushers and box-tickers simply have no idea what it’s like.
When we come to hold someone to account for the deaths of people who are pushed outside the ward for a cigarette and go off to die, we need to start with lawmakers and the Ministry of Health and work our way down. This policy is putting vulnerable people at risk, and it’s taking away the basic human rights of people who are held against their will.
Let’s go on about those basic human rights for a minute. Smoking may be frowned upon, but it’s not illegal. It is a solace to the involuntarily incarcerated of our mental health facilities. Why on earth are we depriving them? What fucked up stupid idea is it to make being in a psych ward even harder than it already is? I have every right to smoke in the real world. How dare the state take that right away from me when they take away my freedom? I’m not a felon; I’m not incarcerated due to breaking any laws. I’m locked up already – what right do they have to make it worse?
One of these days I may be the one you hear about in the news, the one who’s gone missing after being let out for a smoke. For my sake, for the sake of people like me, review this policy. Aren’t people’s lives worth more than an auahi kore sticker? Aren’t the immediate concerns of the rights and lives of real people more important than the long-term risks? Isn’t the right to choice more important than bureaucracy?
Let. Us. Smoke. If you’re going to take our freedom, at least protect our lives.