"The Arundal Unit"

About: Kent and Medway NHS and Social Care Partnership Trust / Inpatient mental health care

(as the patient),

I was very impressed overall with the care and treatment provided on Edgehill Ward at the Arundal Unit in Ashford. The Arundal Unit provides in-patient care and treatment to patients in mental health crisis.

Although the Kent & Medway NHS and Social Care Partnership Trust "rent" space at the William Harvey Hospital on upper floors the Trust have made provisions for those mentally ill that smoke cigarettes in a space designated at the Arundal Unit for those patients that smoke. However on admission when patients mental health can be at its most acute I do not consider it appropriate for the Trust to use whether a patient can go outside for a cigarette in exchange for good behaviour, given the behaviour of some patients, such as myself can be attributed to being forced to go "cold turkey" from nicotine until it is decided whether a patient can go outside and smoke.

Despite the obvious health benefits from not smoking to patients and staff, if detained under the Mental Health Act, patients' should be able to enjoy the rights and freedoms of what is after all a legal activity and some staff, like patients do smoke. If detained in prison inmates are permitted to smoke but patients' with mental illness through no fault of their own often find themselves not just detained against their will, but forced to stop smoking until a Consultant Psychiatrist sees the patient, that may not be for a few days, whereby the patient has to request Section 17 MHA 1983 permission ordinarily required to leave the psychiatric unit just to smoke cigarettes.

I consider that patients' with mental illness should be able to smoke in a safe and secure space and quite often a cup of tea and a cigarette is what is needed to help a patient relax, for a smoker that is.

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Response from Alison Grimsey, E-Communications Manager, Kent and Medway NHS and Social Care Partnership Trust

Thank you for getting in touch, we appreciate your feedback and your views are very important to us. We are pleased that you were impressed by your overall care and treatment on Edgehill ward and I have passed this onto the ward manager.

With regards to the smoking ban you may be interested to know that when the ban on smoking came into effect (July 2007), mental health wards were only exempt for the first year. The William Harvey Hospital (like other hospitals) is a Non-smoking site, but as mentioned some provision is made, in the form of an outside smoking shelter. We know this is not ideal, and this issue will be addressed when Edgehill ward is replaced by our new unit at St Martin's Hospital in Canterbury in November. There, like many of our other wards, outside space can be accessed without leaving the ward and therefore without need for Section 17 leave.

With regards to Section 17, once patients are detained in hospital under the Mental Health Act (for example under Section 2 or Section 3), any leave of absence from the ward must be authorised under Section 17 (of the MHA), and this ‘Section 17 leave’ as it is often referred to, must be authorised in writing by the responsible clinician (this being the Consultant Psychiatrist assessing and making treatment decisions on the ward). Following advice from the Care Quality Commission, this ‘leave’ should also include leave in the grounds of the hospital. In practice, this means that smokers admitted to the ward are routinely unable to leave the ward to smoke, until such time as they have been assessed by their psychiatrist.

We do acknowledge that this can be difficult for patients who smoke, which is why we aim to provide facilities with outside space, as we recognize this is crucial for those who do not have Section 17 leave. Edgehill ward does keep a supply of nicotine patches for smokers to use if they so wish. As I previously mentioned, this issue on Edgehill ward will be avoided when Edgehill is replaced by the new unit in Canterbury.

Thank you for your comments and I hope I have provided you with information which is useful to you.

Many Thanks

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