Mental health patients need smoke-protection too

Clare Allan complains that the "logic" of no-smoking policies in mental-health settings escapes her (The unfair smoking ban will mean fuming on the wards, February 7). We'd like to help. Second-hand smoke is dangerous.

This can be difficult to accept, as tobacco smoke is something very familiar and part of "normal" life. But as much as the pro-tobacco lobby would like to dismiss the dangers of second-hand smoke as overstated and part of an anti-smoking conspiracy, the evidence is clear. In the UK alone, about 11,000 non-smokers die each year as a result of passive smoking. You don't even have to live with a smoker to be at risk - exposure to second-hand smoke among nurses doubles their risk of contracting a life-threatening disease.

From July 1, all indoor public places will become smoke-free. So if we don't want to breathe someone else's smoke, we won't have to. But Allan thinks that if you find yourself being treated or working on a mental health ward, then you should just get used to the smoke because it "is not a health farm".

Allan reminds us that quitting smoking "may not be a priority" for mental health patients. But a no-smoking policy is not about getting people to quit - it's about protecting staff and patients who don't smoke. Smoking will still be allowed in hospital gardens and courtyards.

If there are no secure outside areas (which is unacceptable in itself regardless of smoking issues), then mental health trusts have plenty of time to put this right. They've been given an extra year to become smoke free (up to July 2008).

But it's not just about practical issues. Allan goes on to tell us that there is "a moral argument" relating to banning smoking on mental health wards - especially when patients are there against their will. We agree there is a moral issue here. But it is: how can we force someone to live for several months on a mental health ward and then expose them on a daily basis to a toxic substance? That would be totally immoral.

Of course, we could always confine smoking to designated "smoking rooms". Good idea, except that research has consistently shown that smoking areas provide little or no protection against the toxic substances in tobacco smoke (especially when the door is continuously being opened, wafting the smoke around for all to share).

Nobody denies that there are challenges in implementing smoke-free policies in mental health wards. These policies need to be based on the creation of secure outdoor areas, specialised quit-support for those who want it and, above all, the involvement of patients in the whole process.

The many existing smoke-free mental health units around the country have demonstrated that this can be done. But these examples are unlikely to convince Allan. At the end of her article she concludes that "non-smoking patients and staff deserve to be protected" from second-hand smoke but that a smoke-free policy is "no way to do it". So, Clare, what would your way be? Gas masks?