Smoking 40 cigarettes a day was normal for one North Carolina woman who suffered from a severe mental illness. She had taken up smoking at age 20 – as an inpatient in a psychiatric setting.
Her experience wasn’t unusual, said Dr. Anne Stephenson, the medical director of Central Regional Hospital, the state psychiatric hospital in Butner.
“We see that our patients learned to smoke in the hospital in the past,” Stephenson said. “That won’t happen anymore at our state facilities.”
On July 1, smoking will no longer be allowed at state mental health and substance abuse clinics across North Carolina. Staff and patients who smoke will be encouraged to do it off-campus. The Rules Review Commission approved a rule change last month that removes the requirement that state facilities provide smoking areas.
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The smoking ban is a big change for psychiatric hospitals and clinics, Stephenson said, which historically encouraged smoking because it seemed to calm the patients. Hospitals fostered a culture of staff smoking with patients.
“We don’t have that anymore,” she said. “That sort of cultural change is slow and has taken some time.”
The federal Substance Abuse and Mental Health Services Administration selected North Carolina as one of eight states – and the only tobacco-growing state – to participate in the agency’s State Leadership Academies for Wellness and Smoking Cessation. Their goal is to reduce smoking and to “promote smoke-free living and reduce smoking rates among behavioral health consumers and staff,” according to the campaign website.
State health costs
Smoking is the No. 1 preventable cause of death, according to the 2014 Surgeon General’s Report. North Carolina spends $3.8 billion per year in smoking-related health costs, which include heart disease, cancer, diabetes and lung disease, among others, according to the Centers for Disease Control and Prevention.
The Health and Human Services Department has focused across divisions to try to prevent smoking among the mentally ill and substance abusers.
This target group is especially important because in North Carolina about 41 percent of adults with mental illness smoke cigarettes, almost double the rate among tobacco-consuming adults without mental illness, according to the 2009-2011 National Survey on Drug Use and Health cited by the CDC.
Those who struggle with mental disease are at higher risk from tobacco; they die between 13 and 30 years earlier than those without mental illness from the same causes, Stephenson said. And smoking is the leading preventable cause.
Yet many myths have prevented anti-smoking initiatives in the past. They include that the mentally ill and substance abusers don’t want to quit; that quitting would worsen their disease; or simply that their other addictions make quitting impossible.
“It’s a cultural change – everything is going to have to change together. It’s not going to happen overnight,” said Anna Stein, legal specialist for the Community Transformation Grant Project of the N.C. Division of Public Health. “Your life matters. We don’t accept that ‘You’re a drug addict, so you can’t quit.’ ”
The North Carolina woman who took up smoking as a 20-year-old psychiatric patient is now an outpatient. She has also been smoke-free for five years.
Dave Richard, deputy secretary of Behavioral Health and Developmental Disabilities Services for the DHHS, is excited that state psychiatric facilities are going smoke-free and hopes to encourage private facilities to make similar changes.
“Not only do we want people to recover from mental illness – we have great evidence that they can – we want them to live long, healthy lives,” Richard said. “We’re very proud of our facilities for taking that smoke-free approach, and we are looking forward to working with our communities.”