Psychiatric patients are likely to be offered smoking cessation courses and nicotine therapy as part of an effort to lessen the full impact of the smoking ban in mental hospitals.
A spokesman for the Minister for Health, Mr Martin, confirmed yesterday that the measures were being examined following concern that the ban could result in violent behaviour among psychiatric patients.
However, the Psychiatric Nurses' Association has warned that its members will openly defy a full ban on smoking in the workplace if it means they will not be able to provide cigarettes to patients for therapeutic reasons.
The Mental Health Commission, the independent body charged with upholding standards in the mental health services, yesterday also called for "flexibility and understanding" in the enforcement of the measures.
Mr Des Kavanagh, general secretary of the Psychiatric Nurses' Association, said cigarettes were routinely made available to patients and sometimes used to defuse potentially violent incidents.
"Many patients have been living in a hospital for 10, 20, even 50 years. How do you say to a person who is psychotic or demented and has smoked all their lives that they suddenly can't smoke?" he said.
"A total ban won't happen. The first thing staff will do in that kind of situation is disobey the instruction. The critical thing is to de-escalate the crisis."
Mr Martin is scheduled to meet health board officials and psychiatric nurses in the coming weeks to discuss how the ban will be implemented.
Smoking levels have traditionally been high in psychiatric hospitals and are twice that of the general community.
The availability of nicotine therapy and smoking cessation programmes, which are also being planned for the prison population, are likely to lead to a spike in the cost of providing the services.
The Department of Health spent €4.2 million on nicotine replacement therapy for medical-card holders between April 2001 and October 2002.
The Mental Health Commission also said smoking cessation programmes should be offered and promoted to all residents both in hospitals and residential units.
It added that the regulations should be announced well in advance and advised that residents in hostels or community should be consulted on how the regulations would be implemented.
The chairman of the Irish Psychiatric Association, Dr Justin Brophy, said there should be a relaxation on the ban for patients in residential settings.
"These settings are effectively people's homes. It should be possible to develop a set of regulations for limited smoking in that environment which doesn't impact on staff," he said.
The Minister's ban may also spell the end for health boards buying cigarettes to stock shops in their hospitals. The North-Western Health Board and the Western Health Board have confirmed that its hospitals purchase cigarettes which are available to patients, staff or visitors.
One shop, at St Brigid's Psychiatric Hospital, Ballinasloe, Co Galway, spent €163,000 on cigarettes last year, according to the Western Health Board.
