Louise Ross: why shouldn’t people with poor mental health have the same opportunities as everyone else?

A new guest blog from Louise Ross, Leicester Stop Smoking Service Manager, showing the way with humanity, empathy and humility (previous posts: Let […]

No vaping allowed
Does this give people with poor mental health the same opportunities as everyone else?

A new guest blog from Louise Ross, Leicester Stop Smoking Service Manager, showing the way with humanity, empathy and humility (previous posts: Let there be light! and Who’s health are we talking about?).  Her new guest blog starts now:

Co-creating new opportunities for people with mental ill health

In the last few weeks, we’ve taken some great strides forward with getting ready for vaping (as part of the smokefree strategy) in our local NHS mental health unit.

It must have been a year ago when I was exploring how easy or hard it would be to change the smokefree policy to permit the use of ecigs, for in-patients particularly, and it’s taken this long to move forward. But there has been lots going on in the meantime, and I thought you might like to hear about this, and maybe offer suggestions.

I soon realised that as a lone voice, I wasn’t going to make any headway at all, and that I had to gather fellow advocates (some of whom had to be convinced in the first place) to also make noise about harm reduction. My favourites are listed here:

  • The Charge Nurse (a vaper himself, he has joined me at talks to other staff, and has given me the support I needed, talking from a user’s own experience, but with the added value of his position as a key senior member of staff – someone who is respected and listened to)
  • The Psychiatrist (urgently wanting to find a way of reducing smoking among his patients, but initially 100% hostile to the idea of ecigs. I asked for a meeting with him and he opened his eyes to the potential of ecigs to benefit his patients within the hour)
  • The Medical Director (along with the Chief Executive and the rest of the Executive Team, truly committed to improving the mental and physical health of the Trust’s patients, but unsure of how vaping would be perceived in an NHS Trust. They took a leap of faith and signed off my proposal)
  • The other Psychiatrist (assigned to work with me to make this a reality; he was able to use his own experiences of patients in crisis, seeing that the availability of a vaporiser could have a huge benefit for someone who needed nicotine during a difficult time, helping the person be able to stay calm and in control)
  • The Patient (who told me that when she was admitted, she wasn’t allowed to use her vaporiser but was left to start smoking again; she has given up her time freely to review documents I have written to get the right approach from a patient’s perspective)
  • The Fire Officers (who have shown such patience when it would have been easier just to not allow vaping on the wards; one of their jobs is to make sure patients and staff are protected from harm from preventable fires, and they have worked with me to source fire-safe charging cabinets, and to test whether vapour will set off smoke detectors – not as easy to answer as you’d think, as optical detectors can be set off by an obscuring presence!)
  • The Stop Advisor (who visits the wards and gently and calmly encourages patients when they first show an interest in stopping smoking; she can confidently talk to them about all the choices available, which include licensed products and using their own ecigs)
  • The Communications manager (who helped me set up a staff survey about attitudes to vaping, and will be working with me to make sure the message is heard consistently across the Trust)
  • The Senior Matron (who shows commendable honesty and patience by challenging me on all the issues she is concerned about, because she cares about her patients, and doesn’t want them self-harming with nicotine liquid and broken bits of vaporisers, and who also has to consider the needs of non-smokers; she asks those questions up-front that allow me to prepare answers and solutions for problems that would have arisen further down the line and which could threaten the success of the strategy)

So what have we got? Is it a policy? Is it a strategy? Those who have worked in the NHS will know how complex and prescriptive policies can be and I wanted to give the Trust an opportunity to try out new approaches, and learn from the results. This is an unprecedented change of culture, and one where the outcomes cannot be predicted. Practical issues will have to be addressed: How do patients in secure wards get their ecigs? What type to get into the supply-chain? Where should people be allowed to use ecigs? Bedrooms only? Or will this cause self-isolation? Communal areas? Or will this upset other patients? Outside only? Won’t this destroy one of the key benefits of encouraging a non-smoked/legally permitted product? Then what about staff who want to switch from smoking to vaping, how are their needs to be met?

The main aim though, it must be remembered, is to give people with poor mental health the same opportunities as those in the general population – a chance to stop using smoked tobacco (which harms health and can take up almost all the disposable income of people with mental health problems). We know there are other Trusts wanting to know how it goes, and I’m proud that we can show the way.

Louise Ross

Stop Smoking Service Manager

New Nicotine Alliance Associate

Board of Advisers of CASAA


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23 thoughts on “Louise Ross: why shouldn’t people with poor mental health have the same opportunities as everyone else?”

  1. It is genuinely wonderful that you have taken the initiative and put so much time,effort and commitment into jumping through all the hoops!

  2. Pingback: Mental Health & Vaping - Louise Ross via Clive Bates

  3. You are an inspiration Louise Ross! I work in a homeless shelter and almost all our clients smoke, and about 80% have some kind of mental health problem, from mild to severe. It’s sad to see so many avoidable health problems our people have from years of heaving smoking. And as you said, most or all of the little money they have is spent on cigarettes (in Australia they are the most expensive in the world). Many choose to buy cigarettes over food or accommodation. If only they had easy access to vaping! But it is illegal in my state (WA) to sell both the devices and the juice. So we have a long road to travel here compared to the UK unfortunately.

  4. The NHS is a cumbersome beast, to effect any changes is going to take time, but these are some very positive steps!

    There really shouldn’t be any segregation of service availability to anyone regardless of their condition. If they smoke and wish to stop, it shouldn’t matter if they have a mental condition; anything and everything should be available to them.

    Huge thanks to Louise for your efforts!

  5. Fiona (Fleabag)

    As Louise is aware, as an employee in mental health services, I have a particular interest in the rights of patients and service users to have access to ecigs as the one product that can effectively replace cigarettes and redress a little of the health inequality faced by people with mental health problems. I consider the current trend to ban ecigs in mental health units (and in trust grounds) to be an equality and a human rights issue (I would go further and argue that a patient detained under the mental health act has the right to smoke if they choose, but that’s a different and more complex issue to address).?
    Everyone has the right to choose to make positive health changes in their lives and it is a particularly harsh cruelty to impose nicotine abstinence on people in crisis, given that NRT does not provide the emotional comfort and satisfaction that smoking or vaping does and would rarely be the product of choice for an individual whose priority is their mental state, not whether they are abstaining from inhaled nicotine the way in which policy makers prefer.
    Banning vaping purely on the basis of it looking like an unhealthy activity is a grossly cruel, unnecessary and illogical position. The mental and physical health of the patients should be the primary concern in all policy-making. Actively encouraging vaping amongst smoking patients is the only sensible way to do this.

  6. I want to add my comendations to the ever growing list of those for Louise and her efforts to promote e-cigs and vaping as part of the solution to tobacco use and not as a new problem. I am especially pleased that she has started taking the fight to mental health care facilities. My partner who has treatment resistent schizophrenia and has been hospitalised so many times over the years used to smoke 60-80 cigarettes a day, Schizophrenia in particular has huge numbers of sufferers who smoke at far greater levels than average,she has not smoked a single cigarette in over 3 years, thanks entirely to vaping, all other methods failed miserably and caused a lot of stress. Her health has truly been transformed by vaping. Mental health facilities need to embrace e-cigs wholeheartedly and recognised the undoubted physical, psychological and fiscal benefits they can bring.

    Again, thank you to Louise for continuing to break down those barriers and thank you to those mental health professionals who are willing to listen and at least try.

  7. Riccardo Polosa

    More than 2 years ago we reported surprisingly high success rates in difficult patients with schizophrenia:

    Caponnetto P, Auditore R, Russo C, Cappello GC, Polosa R. Impact of an electronic cigarette on smoking reduction and cessation in schizophrenic smokers: a prospective 12-month pilot study. Int J Environ Res Public Health. 2013 Jan 28;10(2):446-61.

    We also developed a study protocol for a RCT on the same theme, but never got funded….

    Caponnetto P, Polosa R, Auditore R, Minutolo G, Signorelli M, Maglia M, Alamo A, Palermo F, Aguglia E. Smoking cessation and reduction in schizophrenia (SCARIS) with e-cigarette: study protocol for a randomized control trial. Trials. 2014 Mar 22;15:88.

    1. What’s depressing is how SO much money is going into poorly designed and contrived studies to provide negative news flow about vaping, but real-world surveys on their impact and real people facing some of the heaviest health challenges can’t attract funding. A disgrace.

  8. This lady is to be commended for her efforts.I would like to see included ordinary patients included as well.It is well known that the calmative properties of nicotine can be used to help patients,and are preferable to some of the other calmatives’ eg,benzodiazepines etc.Give all nicotine users the option,not just those ,who through no fault of their own have mental health issues!

  9. Bravo, Louise! It has been great to see some progress with regard to e-cigs in relation to the stop smoking services, which I suspect is due in large part to your efforts.

    Thanks for another really interesting article. You – and those whom you have managed to get working with you – are brilliant. I had not realised some of the challenges faced by allowing those with a mental illness to use an e-cig on NHS property; particularly the risk that they might use the components to self-harm.

    I think the fire-safe charging cabinets sound like a good idea. As for where patients and staff should be allowed to vape, other than in their own rooms – assuming that the risk of self-harm can be managed – why should they not be able to vape in communal rooms? There is no proven harm to bystanders from e-cig vapour, that I am aware of. If another patient objected, would this not be a matter of educating the objecting patient? Or, if that would not be possible, could “vaping rooms” be provided, similar to the old smoking rooms? (Less ideal, but a compromise, perhaps?).

    How are these issues being handled in prisons, I wonder?

    I do wish you every success. And I do hope that similar, sensible proposals on vaping will be pursued for ANY patients in NHS hospitals, not just mental health patients. Sudden withdrawal of nicotine affects all of us addicts (smokers and vapers alike) who, for health reasons, have to be confined within a non-smoking environment for more than a few hours. Being able to vape would make such a difference to us.

  10. USEFUL! Professor Ann McNeill, Professor of Tobacco Addiction, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London

    A summary of key points from her presentation to the Royal College of Psychiatry, 16 March 2015 is here along with useful links: Cigarettes, vaping, abstinence

    “Don’t rule out e-cigarettes. They appear more popular than nicotine replacement therapies in the general population and may help smokers to get their nicotine in a less harmful way and perhaps ultimately stop smoking altogether.”

  11. Thanks everyone for the overwhelming support. The first meeting of the Working Group is on 8 May, and I’ll write an update in a few months. Really looking forward to sharing more good news!

  12. Nicki Lollylulubes

    Louise you are a true marvel – thank you for all you do! It is, of course, well recognised that smokers need help to cut down or quit – hence the advent of NRT. NRT was studied for a mere 5 years before being put on the market, although nicotine and propylene glycol have been studied for decades. In 10 years, vaping has harmed nobody, we know it’s unlikely to and that the vapour is of no risk to bystanders. Those immersed in ideology and those with vested interests are determined to conflate vaping with smoking, whereas in fact it has more in common with NRT. Louise’s efforts here and elsewhere, just go to show that when people are willing to listen and learn from an expert on the subject, great strides forward can be taken.

    We know that clinical trials with nicotine have been taking place for some years to treat people with cognitive problems, Schizophrenia, Alzheimer’s, Parkinson’s and Ulcerative Colitis. The reason people with mental health issues smoke more than average, is because they’re self medicating. All smokers know that, in times of stress, the first thing you reach for is a cigarette – for the calming nature of both the behaviour and the nicotine. Smoking behaviour is a deeply ingrained habit which is a primary reason for the success of ecigs; it’s not all about the nicotine, which is why some vapers continue to use ecigs without it to ensure they remain free of lit tobacco. Vaping provides what we need very well indeed, provided we have the right device, nicotine level and flavours for our individual needs. It’s stress free and most importantly there’s no feeling of loss.

    To take away, by force, a perfectly legal pastime from any patient is inhumane and stressful, but for a patient with mental health issues, a disaster. Chief Medical Officer Sally Davies, in her Annual Report last year, said a small study has been done trialling mental health patients with ecigs with great success, some quitting even though they didn’t want to, yet she remains vehemently opposed to them. People like her need educating. What you’re doing Louise is marvellous – you can move mountains and we’re all right behind you.

    Last year, there was a newspaper article about a Matron, Mary Yates, from Maudsley Hospital who was using ecigs for her patients with mental illness. She believed at the time that there was very little research, so I emailed her some links to studies and information and with your permission, included your contact details, Louise. I wondered if she ever got in touch with you, because I believe she may be a good ally in this area. This was her response to me.

    “Many thanks for getting in touch in response to the Bromley Times article which mentioned the approach taken by SLaM in supporting our patients to use them as a cutting down and quitting aid.

    I am pleased to hear your success story and thank you for the links to documents of interest. I am one of the converts to using e-cigarettes as part of the menu of approaches required to treat this addiction.

    I do hope that our experience of supporting patients in SLaM to use these devices will inform the body of evidence and support their wider use going forward.

    With best wishes

    Mary Yates

    Visit our website http://www.slam.nhs.uk

    Four days ago, my friend finally took a chance and invested in a good PV etc., for her partner, who smokes 60 rollies a day and was totally disinterested in vaping. He drives all day and the fact he can vape in the car has proven to be the tipping point and he loves it, is already smoking far less and now wants to learn as much as possible. To say I’m pleased is an understatement. Being able to vape in a place you’re forced to occupy, where you can’t smoke, is a great incentive to switch.

  13. Adam Williams

    Hi louise.
    I am a vendor who is in contact with customers, one on one, daily.
    Not far from me is the Roy Castle foundation and several SSS outlets. Unfortunately the feedback I’m receiving from some customers is that they are still been mislead by said services. Not just the “we don’t know whats in them” but scare mongering as well, such as they put liquids in you lungs and give you pneumonia.
    Hopefully you message will soon spread to this neck of the woods. (Liverpool)

  14. Thank you for dedicating your time to helping people with smoking addictions. Its a real problem and it doesn’t come in isolation. Cigarette smoking mostly becomes the first avenue to other drugs whose addictions are even hard to break. Thank you for the good work.

  15. From my experience it is never easy to stop smoking and working in the health sector most of the diseases caused by tobacco are well known even by smokers themselves.

  16. Pingback: Wales vaping ban: silver lining may be larger than cloud « The counterfactual

  17. Pingback: The letter England’s Minister for Public Health should now write « The counterfactual

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