Doctors writing in the British Medical Journal have warned that exempting certain mental health settings from the smoking ban could have a damaging impact on people's health.
The article's authors believe that the Health Act 2006, which will leave all enclosed public and work areas in England and Wales smoke-free but may exclude certain health settings such as mental health units, will leave the most vulnerable patients unprotected.
Those suffering with mental health problems are more likely to be heavily dependent smokers than the rest of the population, say the experts, who go on to explain that this means people with mental health disorders such as schizophrenia, affective psychosis and others are at a "substantially greater risk" of premature death from smoking.
Further, smoking exacerbates the already high level of social exclusion and health inequality experienced by those with mental health problems.
A leading argument for making the exclusion is that, because some patients are detained in units under the Mental Health Act, they are in fact places of residence. This will be difficult to resolve with the requirement for NHS employers to protect staff and patients from being exposed to tobacco smoke in the atmosphere.
Lending their support to a proposal by the health select committee that psychiatric institutions should not be exempt from the Health Act 2006, the authors suggest that all mental health settings should introduce completely smoke-free policies instead of further excluding mental health patients from mainstream health improvements.