Creating a Smoke-free Environment
Families Outside welcomes the consultation from the SPS on the creation of a smoke-free prison environment. We are a national independent charity that works on behalf of children and families affected by imprisonment in Scotland. We do this through provision of a national freephone helpline for families and for the professionals who work with them, as well as through face-to-face support, delivery of training, and development of policy and practice.
As such, we have a keen interest in ensuring the safety of people in prison, thereby reducing stress and worry on the children and families left behind. The enforced cessation of smoking is likely to raise concerns amongst people both in and out of prison, especially where smoking is used as a coping mechanism for earlier traumas. We are therefore pleased to read that “the SPS will be working with partner agencies to develop a wide range of supports and interventions to assist those in prison to give up smoking.”
1. What steps can SPS take to support those in custody to stop smoking?
First and foremost, prisoners, staff, and families need to have clear, easy to read information about why creating smoke-free prisons is necessary. This could comprise a ‘Q&A’ format including:
- why this is being implemented (including experience of this elsewhere)
- legal rights in relation to a smoking ban
- what the benefits are (health, financial)
- what the difficulties will be (cravings, tobacco as a coping mechanism, tobacco as a currency in prison)
- what the SPS and NHS plan to do to support prisoners (and indeed staff and families) to stop smoking; and
- what prisoners, staff, and families can do to help.
The 2015 report from ASH Scotland1 answers all of these questions. A short publication and/or video written as a collaboration between ASH Scotland, the NHS, ENABLE, and the SPS would go a long way to answering questions, dispelling fears and
misinformation, and eliciting the support of key stakeholders. Creation of smoke-free prisons will not work if prisoners, staff, and families are not on side.
Preparation for implementation should also include discussion groups with prisoners, staff, and families – including mixed groups of these – to share information, allay concerns, indentify barriers, and propose ideas for moving forward. Staff and prisoners could even elect a standing body to represent group interests and raise issues as they become apparent. An important ongoing conversation to include in this is recognition of tobacco as currency in the prison and how to address this.
Physical support to stop smoking will of course be an essential part of the process. Nicotine patches have been used elsewhere, though the use of other methods such as e-cigarettes would need to be discussed. Alternative therapies such as acupuncture (if possible in prison?) and meditation should also be readily available.
While recognising that mental health professionals can often be in short supply in both prison- and community-based settings, ready access to support for mental health will be an important factor in the success of smoke-free prisons. Significant proportions of people in prison are dealing with the long-term impacts of Adverse Childhood Experiences (ACEs) and other traumas, often struggling with mental ill health as a result. A smoking ban leaves people suffering from trauma without their usual coping mechanisms. This puts enormous strain on prisoners, but also on the SPS and NHS staff left to manage them.
The methods we suggest here will involve financial investment, in terms of written or other visual materials, facilitation of focus groups, and additional support for physical and mental health. This investment is important, however, in view of the serious consequences of getting this process wrong. Further, the more the SPS can manage the smoking ban as something of mutual benefit to staff, prisoners, and families requiring mutual supports – rather than something simply ‘imposed’ upon people in prison – the more successful and peaceful the transition is likely to be. We commend the SPS for allowing time for this process and for consulting on how best to take smoke-free prisons forward.
2. How can we help families to help those in custody?
First, families need to be informed of, and included in, the process. As noted above, including families in group discussions alongside their family members and prison staff may be a useful way of ensuring their voices are heard. At the very least, information needs to be available to families via prison visitor centres, including information sessions and discussion groups alongside prison staff, NHS staff, and visitor centre staff.
Prison visitor centres often have positive working relationships with community-based
NHS staff. The visitor centre at HMP Addiewell, for example, recently won an award alongside NHS Lanarkshire for their work on smoking cessation. These are good examples that can be built upon to support families in creating smoke-free prisons.
Families will be worried about the wellbeing of their family members in prison, especially if they believe smoking is a means of coping with trauma, anxiety, or depression. Showing families clearly how they can support their family member when smoke-free prisons are fully implemented will therefore be of critical importance. Again, simple Q&A-style information will help with this. However, there are other means of involving and supporting families throughout this process. In partnership with the NHS and prison visitor centres, families could join their family member in prison in their efforts to give up smoking, maybe creating a system of ‘empathy buddies’ to support each other to quit. Knowing that their families are joining with them in their efforts to stop smoking may help, not least because it means families are less likely to trigger cravings by coming into visits smelling of smoke.
Something that keeps the process as positive and rewarding as possible, both in and out of prison, is likely to be more beneficial than a more directive or punitive approach. Even the SPS’s choice of language – ‘creating a smoke-free prison’ rather than a ‘smoking ban’ – is both welcome and important. The NHS has extensive experience in this, and whether it’s introducing something like ‘I’m a quitter’ t-shirts to reward people who manage to stop, or introducing families to groups within a visitor centre or online fora to assist, or linking people with community-based groups for support, NHS and visitor centre staff will be an invaluable resource.
Another message of benefit may be showing the financial benefits of cessation. This may mean showing families that handing in money to their family member goes towards more telephone credits or better food from the canteen – or alternatively that quitting leads to less stretched finances at home. A number of prison visitor centres engage with Citizens Advice Bureaux, which again may be able to highlight the financial benefits of stopping smoking.
3. What range of measures should SPS aim to put in place?
Most of the measures the SPS can put into place are ones we highlighted in our response to question 1. Again, these include:
- clear, simple written information and videos
- discussion groups, including a standing group of prisoners, staff, and possibly families
- engagement with NHS staff, including additional mental health support
- nicotine patches, possibly e-cigarettes (or consideration of these), and alternative therapies such as acupuncture and meditation.
Prison staff should be equally engaged in creating smoke-free prisons, with consideration of prison staff who are trying to quit smoking pairing up as ‘empathy buddies’ with people in prison who are being forced to quit. The mutual support between prisoners, prison staff, and families is potentially a very positive approach to a very difficult process.
Importantly, measures to create smoke-free prisons should not be punitive. As an addiction, smoking is a health issue, often related to coping mechanisms for backgrounds of trauma, as noted above. With new people entering prison all the time, this recovery-focused, non-punitive approach will need to be an ongoing process.
One way of doing this is to bring efforts to stop smoking into wider health improvement activities. The running project at HMP Grampian is an excellent example of this. Introduced as a joint project between Families Outside, a PhD student at the University of Aberdeen, and NHS Grampian, alongside staff at HMP Grampian, this project initiated a running club at the prison in which participants learned of the benefits and techniques of running, set goals, kept diaries, and took part in ‘fun runs’ alongside their colleagues, staff, and volunteers. Based on a similar project the PhD student started for prisoners and their families alongside Children of Prisoners Europe member Bambinisenzasbarre in Milan, Italy, the project noted a wide range of health benefits, with reductions in smoking as one of them.
The running project extended to participation of families in sports events and activities in the prison visitor centre, visits hall, and wider community. This has since expanded into a community-based project with Streetsport Scotland, which engages families and prisoners on their release to get involved in their local community through sport and fitness. This model has many facets to commend its use in the SPS’s efforts to create smoke-free environments in prisons.
4. Whom should SPS be engaging with when planning the move to smoke-free prisons, and following implementation?
The SPS must remain in constant discussion with representatives of staff and prisoners, ensuring a mix of smokers and non-smokers. This will ensure that both staff and prisoners always have a voice and someone to go to, to represent their concerns and address any new or unexpected developments as they arise. Information for prisoners, staff, and families must be clear and readily available, ideally developed in collaboration with organisations such as ASH Scotland and ENABLE.
NHS staff in and out of prisons are well-experienced in efforts towards smoking cessation and will be of key support in efforts towards implementation. This includes links with staff at the State Hospital in Carstairs regarding their own implementation of a smoke-free environment, the challenges they faced, and how they addressed these.
Also noted above, regular interaction with prison visitor centre staff in their support of visitors will be a huge asset, creating a means of bringing families on board as much as possible. Vistor centres also have the benefit of links with community-based supports such as the NHS and CABx, which can provide on-site information as well as links to community-based supports for families. Prisons without visitor centres will need to consider how to provide equivalent support in their establishments. Families Outside staff may be able to advise on this.
Last but not least, engagement with researchers experienced in this area of research will be crucial to providing information, answering questions, identifying potential pitfalls, and building the learning from such a process. The work that ASH Scotland produced in relation to the implementation of the smoking ban at the State Hospital is particularly valuable, as is the ongoing Tobacco in Prisons (TiPs) study. Academics such as Richard Sparks from the University of Edinburgh, Laura Piacentini from the University of Strathclyde, and Ben Crewe from the Institute of Criminology in Cambridge may be well-placed to advise on the sociological implications of creating smoke-free prisons, particularly in relation to tobacco as a currency in prisons. Discussions with such experts would be highly beneficial at an early stage.
5. Do you have any other information that you think would help us deliver the aims of this project?
The 2015 ASH Scotland report includes an extensive range of resources at the back to assist agencies in their efforts to implement smoke-free environments. These resources should prove very useful, ideally along with a new resource commissioned specially for use in prisons.
6. General Comments
Families Outside is grateful for the opportunity to comment on this important issue. The SPS is well versed in the types of problems implementation of smoke-free prisons is likely to produce, and we commend the SPS for consulting and planning ahead to prepare for these. We particularly welcome the recognition and inclusion of families as key stakeholders in this discussion: having families on side should ease the difficulties of enforced abstinence, while having them acting in opposition would no doubt enflame the situation.
Ensuring prison staff are on board as allies rather than enforcers will also be critical in the smoking ban’s success. We are grateful to have a prison service in Scotland that strives to build positive relationships with the people in its care – something that makes a considerable difference.
We are happy to elaborate on any of these responses, should the Scottish Prison Service require additional information.
1 ASH Scotland (2015) Smoking and mental health: a neglected epidemic. Available at https://www.ashscotland.org.uk/media/6671/ASHScotlandSmokingandmentalhealth.pdf