Graham Roper wants smoking banned at Wakari and said smoking, like any addiction, should be managed as part of a ''whole of health'' treatment programme.
But others disagree.
The Southern District Health Board will consider a smoking ban as part of a policy review.
Mr Roper used to be the board's mental health consumer adviser and, in that role, supported a smoking ban on hospital grounds in 2010.
It was not implemented in full because board member Richard Thomson argued locked-in patients at Wakari should be allowed to smoke - an opinion he stands by.
The debate was reignited when a Wakari secure ward patient raised concerns about a smoking ban last week.
A board spokesman told the Otago Daily Times the policy review would take into account a pending High Court decision in a case involving the Waitemata District Health Board.
Mr Roper, an adviser to the Royal Australian and New Zealand College of Psychiatrists, said secure ward patients at Wakari were not allowed to drink alcohol, for various reasons, and should not be allowed to smoke either.
''In any health facility, smoking should be banned. If you are put in isolation in another part of the hospital you can't go outside and have a smoke, and psychiatric wards are no different.
Secure wards were an ''ideal'' environment to manage whole of health and provide support for smoking-addicted patients, many of which had low incomes and shorter life expectancy - problems made worse by smoking, Mr Roper said.
He said cigarettes altered the efficacy of some anti-psychotic drugs and some smokers had to be given higher doses, which put them at greater risk of side effects.
A smoking ban would also prevent patients using synthetic cannabis products and, in some cases, might reduce aggression among patients vying for cigarettes, he said.
Mr Thomson said patients were not admitted to Wakari because they smoked, and the board had no right to treat them for smoking addiction.
He agreed with Mr Roper that smoking was detrimental to health but said secure ward patients should be allowed to smoke if they chose to.
''I totally endorse the view that other patients and staff should not be able to smoke on hospital grounds and if they want to smoke, they should leave the grounds to do so.
"But where I draw the line is when we lock people up - for people who are unable to leave because we've locked the door, the rules have to be different.''
Even patients in medical wards could ''drag their drips'' outside to smoke, he said.
Mr Thomson said the board should support patients who wanted to stop smoking, but research showed those forced to quit while locked up almost always started again once released.
