Service User Voice: Light a cigarette for me

When I worked with people with alcohol problems, I would sometimes meet carers who were worried about their clients’ drinking.

One of the first things I would say was: “Be clear about what you think is the problem, or problems. Are you worried about their health, or safety, or yours? Is their behaviour abusive or frightening when they have been drinking? Is it that you’re uncomfortable around someone who’s been drinking, because of the way you feel about alcohol?”

None of them are “better” or “worse” reasons for being worried: professional carers have a duty of safety towards their clients, and a right to feel safe and comfortable in their working environment. When they thought about it, most of these carers were concerned because they didn’t want to collude with what they saw as self-harming behaviour, either by buying alcohol, or by pouring their clients drinks they were also worried that they would be accused of failing in their duty of care.

When people had worked out exactly what they were worried about, they could work out what they wanted to do about it. Usually, this meant letting clients know that buying alcohol for them was not in the job description, and that they would be failing in their commitment to care by helping someone drink excessively.

By establishing their professional boundaries, carers could begin to address the problem without dictating how their clients should live.

Jump forward 15 or 20 years. The ban on smoking in enclosed public spaces is being enforced, and one of the reasons for the ban is to guarantee a smoke-free working environment. People’s homes are excluded, even though they might be other people’s workplaces.

Care homes, hospices and residential units are counted as people’s homes. It’s recognised that smoking plays a large part in the lives of many mental health service users – 70% of mental health unit users smoke, and 50% of those smoke more than 20 a day. Does their “right” to smoke trump workers’ “rights” to a smoke-free workplace?

I smoke. I’ve smoked all of my adult life. I know I ought to give up, but it’s one of the few “normal” things I can do. Because I can’t use my hands, I need someone to buy and light my cigarettes, and clean ashtrays. If you were one of my PA’s, what would you do?

Simon Heng is a wheelchair user and is involved in user-led organisations