LAKEWOOD, Wash. – A smoking ban at the state psychiatric hospital here is being criticized by some researchers who say nicotine can help people with some forms of mental illness.

Western State Hospital, one of the largest psychiatric hospitals in the western United States, recently banned smoking on its entire 540-acre campus in the interest of patient health. Previously, only indoor areas had been smoke-free at the hospital south of Tacoma. "I have a 24-year history in psychiatric hospitals, and I've seen a tradition of giving out cigarettes as rewards," said hospital Chief Executive Officer Jan Gregg. "We've gotten away from that, but this totally closes the loop. People should have the right to smoke, but this hospital is a health care facility, and we need to promote healthy habits." Gregg said a year of research found rising costs to treat smoking-related heart problems. The hospital now offers nicotine gum, patches and smoking-cessation classes instead of cigarettes to its 794 patients. But critics say the ban is a bad move, as research indicates that people with schizophrenia can benefit from nicotine. Schizophrenics' "nicotine receptors" seem to be chemically different, said Dr. Robert Smith, a psychiatry researcher at New York University's Medical School. Nicotine appears to help lessen the cognitive deficits that plague people with schizophrenia, including problems with attention span, memory and organization of their thoughts, he said. Other medical researchers say nicotine reduces the potency of mental-health medications, which in turn reduces side effects like sexual impotency. The hospital banned outdoor smoking a year ago for its criminal commitments unit. Administrators wanted to extend the ban to those patients who are civilly committed, as they are given more freedom to walk around the grounds. Once-smoky entryways have cleared and there has been no rise in confrontations, said Gregg and her staff members. At least five other states, including Oregon, have imposed similar bans in the past five years. California is also considering a ban. The North Texas State Hospital was one of the first in the country to ban smoking. Assaults at the hospital dropped by at least a third after the 1997 ban, said spokesman Jerry McLain. But three other states threw out campuswide smoking bans after they proved problematic. Montana State Hospital in Warm Springs uncovered a black market of sex-for-cigarettes. "When you ban it campuswide, you drive it back inside," said Hal Wilson, chief executive officer of Washington's other adult psychiatric facility, Eastern State Hospital near Spokane. The issue of patients' rights is also being explored. One Massachusetts-based group considered filing lawsuits on a constitutional right to smoke but dropped the idea when federal courts ruled that jail inmates do not have that right.

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