People with mental health issues are more likely to suffer from very poor physical health outcomes, living with more physical illness and dying at an earlier age than the general population.
One particular reason is that a combination of factors lead people with mental health issues to smoke more, to be more addicted to nicotine, to smoke more cigarettes per day, and find it harder to quit. One third of tobacco in the UK is used by people with mental health issues, amongst whom smoking rates are not declining as in the rest of the population.
Scotland’s current mental health strategy runs to the end of 2015. The development of a new strategy is underway and creates the opportunity to address the impact of physical health, and in particular smoking, on the lives of people with mental health issues.
One barrier to change is that smoking is often considered to be a support and coping mechanism, leading to a perceived trade-off between mental and physical well-being. Yet this perceived conflict is something of a red herring – smoking does not support mental health and indeed the opposite is true. There is now good evidence that stopping smoking is linked to improvements in depression, anxiety, stress and psychological quality of life.
So while many people reach for a cigarette to alleviate immediate stress or anxiety, what smoking does is to reduce nicotine withdrawal symptoms (which are similar). It does not reduce anxiety, instead adding the cycle of highs and lows of nicotine craving and satisfaction on top of any underlying problems.
In speaking to staff at mental health services, and hearing the voices of service users themselves, we have found that the link between smoking and mental health is not well known and that there is a lack of central, strategic direction in this area. Therefore the myths are not being challenged, the issue is not being addressed and people with mental health issues are not receiving the help and support they need.
The new mental health strategy provides the ideal opportunity to present a clear message that smoking is part of the problem, that high smoking rates are causing both mental and physical harm to this vulnerable group and that we need to work with people with mental health issues to find positive alternatives for the roles that smoking currently plays.
With the client group themselves expressing strong support for quitting anything less than a clear ambition to tackle smoking would be to fail those relying on health and well-being services for help.
A full evidence review on smoking and mental health, including references for the figures used in this article, can be found at: http://www.ashscotland.org.uk/media/6671/ASHScotlandSmokingandmentalhealth.pdf