Regina L. Xhezo
Manager of Special Projects for the CMO
Community Behavioral Health (CBH)

Imagine a world where the #1 buyer of cigarettes is NOT a person with a mental illness or substance use disorder.

Imagine, again, a world where the life expectancy for people with a behavioral health challenge mirrors that of the general public:  70-75 years instead of 45-50 as it is now.   What would people in recovery do with the extra 25 years of life? 

Imagine, once more, a world where clean air regulations and expectations DO NOT discriminate and are evenly applied to ALL hospital settings:  general hospitals and psychiatric hospitals alike.   Wouldn’t this be healthcare equality at its most basic, fundamental level?

The first two scenarios are some time off but within our reach, if we all begin to open our eyes, today.  But the last scenario, I am thrilled to report, will soon become a reality across Philadelphia.

On December 14th, 2015, Philadelphia is making history. ALL 12 psychiatric hospitals across the City will unite by enacting tobacco-free campuses, this includes cigarettes, e-cigarettes, cigars, and chewing tobacco. This will be the first step of many that will support the Philadelphia Department of Behavioral Health and Intellectual disability Services’ dedication to addressing tobacco disparities across its provider network and to improve the services offered to individuals who smoke.  Our eyes are open to the crisis that exists and we are compelled both ethically and morally to do what we can to change the status quo.

This change will inevitably bring up questions.

Do we offer a person with alcohol or drug dependence a Budweiser when he or she presents for psychiatric treatment?  Why not?

Both alcoholism and cigarette use are addictions but we turn a blind eye to cigarettes.  Yet more people die from tobacco-related illness than alcohol dependence.

Beginning December 14th, there will no longer be the usual 4-7 smoke breaks a day at Philadelphia psychiatric hospitals.  Instead, the 1-2 hours a day taken away from treatment to smoke will be replaced with healthier alternatives and what the individual is there for:  TREATMENT.

But won’t this tobacco-free policy cause chaos on the units you ask? 

Research resoundingly says “NO”, this is not the case. Fights and other aggressive incidents do not increase on tobacco-free psychiatric units.  In fact, due to the eliminated need to bargain and negotiate for cigarettes, patients and staff can develop better, more productive relationships.

But the time spent on the psychiatric unit is not long enough to effect change, is it? 

Actually it is.  After only 72 hours after stopping smoking, all the nicotine from previous cigarettes has left a smoker’s body and breathing has begun to improve.  In 5-10 days, smoking cravings have begun already to decrease and the heart rate begins to return to normal.  The human body is amazing and does its best to rid itself of the toxins at a fast rate.

We realize that this will be a challenge for smokers and have taken many steps, alongside the psychiatric hospitals, to ensure that the individual’s stay is as comfortable as it can be without relying on smoking.  All smokers who present at a Philadelphia psychiatric hospital will be offered at admission nicotine replacement therapy, such as the patch or gum, and additionally offered smoking cessation counseling by someone trained in behavioral health and tobacco use disorder.  It is the hope that a smoker’s average 3-7 days stay at the inpatient unit will be used as a jumpstart to their tobacco use treatment that will continue after they are discharged.  It is unrealistic to think that this will work for everyone, but if it helps only a handful, we have made a small but impactful change for the better.

Join the Tobacco Recovery & Wellness Initiative (TRWI) as we celebrate December 14th, 2015 as the first day patients, staff and visitors at Philadelphia psychiatric hospitals will breathe fresher air and focus more on what matters the most:  RECOVERY.

Want to get involved with TRWI? Please visit: Want to learn more about tobacco & behavioral health? Please visit: