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Daily Archives: March 20, 2009

Two issues fellow bloggers have taken up

1. Smoking in psychiatric clinics and hospitals

Jim Belshaw went rather over the top in his title, but I do agree with the post: NSW strikes another Hitlerian blow. The issue, as Jim says, is one of compassion versus “being right”.

I quote from the Sydney Morning Herald:

A ban on smoking in all psychiatric facilities will go ahead despite vehement opposition from some members of the mental health community, who argue that strict anti-smoking rules will destabilise acutely ill patients and put staff at risk of violence.

NSW Health has ordered all facilities, including emergency psychiatric centres, to close designated outdoor smoking areas, confiscate tobacco products and supply free nicotine replacement therapy to staff and patients.

If accurate, this is one of the most inhumane statements I have ever heard.

A comment from a schizophrenic endorsed that, as did I. So too in today’s Sydney Morning Herald letters does a practitioner in the field.

As a doctor I strongly support anti-smoking policies. But there are specific issues relating to mental health patients that make the move against smokers by NSW Health deplorable ("Tobacco ban leaves mental health groups fuming", March 19).

Mental health patients may be voluntary or involuntary. Voluntary patients may simply stroll off the hospital grounds to smoke. But involuntary patients are detained against their will in hospital under the Mental Health Act and are not allowed that liberty.

They are by definition so mentally disordered that the last resort of the act has been invoked because they may be a risk to themselves or others. These patients are frequently agitated and smoking is one method they use to calm down. In this state they lack the capacity to consider the benefit of stopping smoking, and this is clearly not the time in their lives to introduce intransigent non-smoking rules that only escalate their agitation.

In the past these patients were allowed to go outside to smoke escorted by security staff, but since the introduction of smoking bans they may no longer do so. In hospitals all over NSW these poor individuals are being physically restrained and given sedative drugs when their agitation escalates. This infringes the spirit of the Mental Health Act, which stipulates that it may be invoked to detain a person only when there is no less restrictive means of doing so. Clearly allowing them to smoke is far less restrictive than physical restraint and sedation.

We already make these patients suffer protracted stays in crowded emergency departments, due to the failure of NSW Health to provide beds for them. It is easy to imagine what effect this has on individuals who are at the lowest ebb of mental wellbeing. To add insult to injury they are now told that their last vestige of self control – to seek solace with a smoke – is being withheld, in what must seem an arbitrary and cruel act by their carers.

Doctors are placed in the unenviable position of choosing to restrain the individual or to let them out on their own, with the risk they may abscond and harm themselves. What a sad state we have sunk to.

Dr Alvaro Manovel Randwick

There is a contrary letter too, but I know from experience and observation that the idea really is a bad one – whatever you think about smoking.

Jim also expresses lack of surprise over the defeat of the alcopops tax, and I agree in fact that it was never the most brilliant of ideas and suspiciously like a tax grab rather than a well thought out policy on the social problems caused by alcohol. On the other hand, imperfect as it was, I am sorry it was defeated, particularly because I think Senator Fielding (Family First) was using his new-found power in a naive and unconsidered way. Pass it and agitate in future for better, I would have thought, which is more or less Bob Brown’s position. All that has been achieved is another problem for the economy.

2. That alleged list of sites on the government’s internet filter black list.

My position on the folly of the involuntary Net Nanny the Rudd government is so keen on is clear enough from the top of my side bar. Recently a certain site, which apparently is now on the black list itself, published what it says is the black list. That leaked list included a number of very odd choices. See Dentist, tuckshop cited on web blacklist.

Websites contained on it will be blocked for all Australians once the government implements its mandatory internet filtering scheme – originally pitched as targeting only "illegal" content – later this year.

But, as experts have long warned the government, having a top-secret blacklist of banned sites is dangerous because there is a real danger that Australian businesses could be added to the list in error, with little recourse.

Bruce has posted (with ironic discretion) here, Arthur here, and Pip Wilson here — “Senator Conroy’s and the Australian Labor Party’s infantile Internet witchhunt”.

Update Sunday 22 March

Go to Wikileaks threaten Conroy with extradition proceedings.

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