Let’s talk about smoking and mental health Reply

In the run-up to May’s elections for the Scottish Parliament, ASH Scotland has produced a manifesto of issues it would like the incoming Government to address.  The document focuses on health inequality, which is acknowledged by all political parties to be one of the biggest challenges our society currently faces – and nowhere is this gap more acutely felt than amongst people experiencing poor mental health.

We know that smoking prevalence is higher amongst those with mental ill-health and that the reasons for this are complex, with continued smoking relating (in part) to issues around coping and relieving stress or boredom.  But there is good evidence to show that stopping smoking can lead to improvements in levels of stress, anxiety and depression.  It can also, in specific situations, mean reduced medication levels for illnesses such as schizophrenia, where smoking interferes with how some drugs are metabolised (leading to higher dosage levels, with all their attendant side-effects).

Additionally, we know that people who experience poor mental health are just as motivated to quit as anybody else and – crucially – that they are equally entitled to the opportunities and support to do so.  In reality, however, there appears to be quite a disparity in approaches towards smoking in different settings – for example, in mainstream hospitals there is an acknowledgement that smoking is contributing to ill-health; this is not necessarily the case in some mental health settings, for either the physical or mental well-being of patients.

But relationships between stop-smoking lobbyists and advocates for mental health have sometimes been strained – with issues around an adult’s choice to smoke and having further prohibitions placed on people who already feel that they have many things ‘done’ to them (often against their will) being foremost amongst differing points of view.

In recent discussions that we’ve had with mental health organisations and advocacy groups, however, what has become clear is that there are many points on which we can agree:  that physical health outcomes for people with mental health issues are unacceptably poor and that smoking plays a part in this; that there is a general lack of knowledge about the impact that smoking can have on mental health, which inhibits notions of ‘informed choice’; that there needs to be better and clearer leadership and communication, from statutory agencies as well as voluntary organisations, about these links between smoking and mental health; and the part that electronic cigarettes can play, not only in reducing harm but also in supporting smoke-free settings for all.

So perhaps we can think about how we best communicate some of these ideas with each other – for example, instead of talking about a “smoking ban”, with its negative connotations of prohibition and lack of choice, we discuss “nicotine management”?  This would recognise that smoking is an issue which needs to be acknowledged as having specific attributes (i.e. that it’s addictive and harmful) and should be considered in the same vein as problematic alcohol and/or drug use, for which people would receive help and support when accessing services.

And a social justice approach to addressing smoking, instead of the standard medical model, may prove to be the most effective way to start conversations around tobacco for people with mental health issues, one which looks at the huge health inequalities experienced by this cohort.  Posing the question “would such inequalities be tolerated by any other section of society?” could be a way ‘in’ to such discussion and may, in turn, help put the emphasis on empowering people to make a positive change in their lives.

Some of these issues are going to be discussed at the Scottish Tobacco-free Alliance symposium on Smoking and Mental Health, being held on 23rd February in central Edinburgh.  We would welcome input from mental health voluntary organisations and advocacy agencies, so do get in touch via the link above if you’d like to attend.  It’s free and fully accessible.

Linda Bates, Development Officer

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