America's Mental Hospitals: Where Smoking Buys You Sunshine

Imagine a place in the United States where most everyone smokes, where smoking is in fact encouraged, where cigarettes are used as rewards, and where at times, you may even be denied outdoors unless it's for a smoke. I know it sounds crazy in this day and age of "no tampering with smoke detectors" in lavatories and smoke-free bars that such a place could exist, but it does. Crazier still, this smokers' paradise exists -- in fact thrives -- within establishments charged with the very task of combating insanity, namely, our mental hospitals. And while we're on the topic of insanity, it's worth noting here that this includes correctional facilities, as prisons are now this country's largest mental health facilities.

While I've never been convicted of a crime, I have spent my fair share of time in private mental hospitals, wherein I've witnessed what may well be our nation's last great bastion of tobacco, tar and nicotine.

Though it has been five years since my last inpatient psychiatric hospitalization, word on the street is that things haven't changed. Stop by any parking lot after a mental health support group meeting and you'll see for yourself. You don't need to work hard to convince anyone with a mental illness that smoking is a serious and widespread problem within our community. We know it all too well, both first and secondhand.

But should you be reluctant to accept the word of a lone writer and former mental patient, I refer you to an opinion piece published last week in JAMA Psychiatry. The authors -- Jill Williams, MD; Jeffery Willet, PhD and Gregory Miller, MD -- effectively summarize their case in the title of the editorial: "Partnership between Tobacco Control Programs and Offices of Mental Health Needed to Reduce Smoking Rates in the United States."

No argument here. Still, more and stronger partnerships are needed. As the authors note, smoking rates are at least twice as high among those of us living with mental illness than among the general population. Over 75 percent of people with serious mental illnesses are addicted to tobacco products. Add to this the fact that our obesity rates are also significantly higher than those of the general population, and it's easy to see why our incidence of cardiovascular disease, as well as lung and other cancers, blows away that of our "normal" counterparts -- let alone why, on average, we die 25 years sooner.

Given these gloomy statistics, it's clear that public health professionals, mental health providers and health policymakers need to step it up all around when it comes to tobacco prevention and cessation measures. Together, they must do whatever is in their power to ensure that people with mental illness get better access to and coverage for tobacco prevention and cessation programs. Still, that's not enough.

People like me -- those of us in the trenches, who struggle personally with serious mental disorders on a daily basis -- have stood on the sidelines here for far too long. At this point, our problem isn't just that the cards are stacked against us. It's that we're not even in the game.

The first full cigarette I ever smoked was in the small outdoor atrium of an inpatient psychiatric facility. Only smokers were permitted in the atrium outside of certain specified time periods, so that cigarette was my ticket to sunshine.

No one should ever have to make that kind of trade-off.

By joining with mental health providers, public health professionals and policymakers to demand more and better smoking prevention and cessation efforts, those of us living with mental illnesses can lead this charge and foster a new smoke-free culture among ourselves. True, this would require a huge cultural shift in our community, but it's not an impossible one. We've seen dramatic shifts within the general American population's rates of and attitudes toward smoking over the past 60 years, so we know that meaningful change is possible.

Now it's up to those of us living with mental illnesses to get off the sidelines, step out of the shadows of shame, and get our brains and bodies in the game. It's time we join together, stand up for ourselves and speak out for all our coughing and wheezing comrades who can't.