ASH Scotland Inequalities Development Lead Mary-Grace Burinski writes for Tobacco Unpacked about a recent summit organised by ASH Scotland and the Scottish Tobacco-free Alliance:
I set out to write this blog and was struck by the fact that a lot of what I was going to say had already been said in other blogs by numerous people, in numerous ways, on numerous occasions. Each article had a slightly different focus, but the premise remained the same: not enough is happening to address smoking rates amongst those with lived experience of a mental health condition.
So, back to the particular focus here – the 3rd Scottish Summit on smoking and mental health: “Compassionate care for smokers experiencing poor mental health; all part of aiding recovery”. A few years have passed since the last time we came together to discuss the challenges involved – the previous events had taken place in 2005 and then 2009.
So, what’s changed?
Let’s start with the positives. We had engagement from a wider audience (not just those pesky “anti-smoker do-gooders”). Community mental health staff, health improvement, prison service, third sector mental health service providers, advocacy organisations, charity and voluntary organisations, academia, as well as stop-smoking services were all represented. Cultures are also changing, but slowly: things are moving in the right direction, but it is taking time. More and more staff supporting people with lived experience are now gently opening the door to discussing smoking, when before it remained firmly closed.
In terms of the negatives, it is still not enough. Prevalence rates are still not changing. The same problems still exist: lack of leadership and guidance at national and local level (which was also cited in previous summits); although the culture is getting better it still isn’t there yet; and a lack of consistency in approach remains across the country. The bottom line is that it is still not seen as a priority issue.
I am reminded of the conversations we had with maternity services many years ago in the early days of engaging on the topic of smoking during pregnancy. Back then it was still a taboo subject. Common arguments we heard were: “what about the damage it would do to the woman’s relationship with the midwife who asks?” and “what about the guilt she would feel about harming her unborn child?” It was just not appropriate to ask “THAT” question. Sound familiar? Compare that with today where routinely, across the country, pregnant women are asked about their smoking habits, tested for carbon monoxide and referred to stop-smoking services where appropriate. What made the difference? There was leadership, there was guidance, it became a national priority.
What lessons can we learn from this as we think about the challenges we face with smoking and mental health? Firstly, just because it isn’t easy doesn’t mean we shouldn’t bother. More importantly, it isn’t about enforcement or compulsion to stop smoking. It’s about the inequality which exists when we don’t give a particular group within the population the same opportunity as the general population. When we shy away from tackling a problem (as we once did with pregnant women and are still doing with mental health) we are complicit in allowing that harm to continue.
Finally, we can’t underestimate the importance of having that national driver, that national push. It was a message which came through very clearly from the Summit. We have the opportunity now to change that with the development of the new mental health strategy. Let’s not lose it, let’s give this issue and the practitioners on the ground the national support it deserves.
For more information about this topic, please see our evidence review entitled Smoking and mental health: a neglected epidemic.
Development Lead – Inequalities