In the Sites of Exception: Smoking and Mental Health Inpatient Facilities in Aotearoa New Zealand

Abstract

In Aotearoa New Zealand, mental health inpatients are entitled to treatment in smoke-free hospital care environments. However, in 2003, the Parliament of Aotearoa New Zealand exempted hospital care institutions from the smoke-free law, thus permitting designated smoking rooms for patients, subject to specific provisions including ventilation. Subsequently, District Health Boards (DHBs) implemented smoking rooms in mental health inpatient facilities and exempted them from the general smoke-free rule in their smoke-free organisational policies. My curiosity inspired this research to understand the rationale for the smoke-free policy exceptions in DHB mental health inpatient facilities and the implications of the exceptions for patients, staff, and Smoke-free 2025; the Aotearoa New Zealand Government’s national goal, which is “interpreted to mean that less than 5 percent of New Zealanders of all ethnic and social groups will smoke daily by 2025” (Ministry of Health, 2021, p. 4). The theoretical framework guiding this study is Giorgio Agamben’s state of exception. I collected data from 15 semi-structured interviews, archival material, and DHB smoke-free policies. Reflexive inductive thematic analysis was used to code and generate insights from the Participant data. This study is noteworthy. It is the first academic research examining the use and implications of exceptionalist smoke-free law, policies, and practices in mental health inpatient facilities in Aotearoa New Zealand. It also documents the State’s role in purchasing and supplying tobacco and cigarettes to mental health inpatients and begins to fill a gap in the knowledge about the foundations for pervasive smoking in these facilities. The use of Agamben’s state of exception to explore one exceptionalist law, policies, and practices in a mental health setting is novel. It adds to the body of literature that uses this lens to examine non-cataclysmic events. My key findings are that smoke-free exceptionalist law permitting designated smoking rooms and partial smoke-free policies and practices that facilitate and endorse cigarette smoking are forms of patient control and sites of violence. These sites disregard the accepted research evidence of harm from smoking and exposure to second-hand cigarette smoke, expose patients and, to a lesser extent, staff, to these health detriments, and make it more likely that mental health patients will be among those still smoking in 2025. Furthermore, the presence of a law permitting patient smoking in hospitals is inconsistent with Aotearoa New Zealand’s international and domestic human rights obligations. My thesis concludes that a government serious about improving, promoting, and protecting health and wellbeing must amend the law and ensure hospitals are smoke-free. Smoke-free exceptions denigrate the value of human life: the life of people who smoke and are patients in mental health facilities.