The Scottish Government is now consulting on plans for a 10-year mental health strategy for Scotland.
People with mental health issues are over-represented amongst the smoking population – so much so that a third of tobacco consumed is by this group. The consultation document is brief, with a succinct overview of the priority areas and actions and the opportunity to reply to 3 questions. ASH Scotland responded along the following lines:
The first question asked if the priorities outlined were the right ones. With regard to our interest we said that, largely, yes this was the case. We welcome the explicit reference to improving the physical health of people with mental health issues (Priority 6), which is a very positive step forward. With this group dying 10-20 years earlier than the general population this is a clear priority.
However we do feel that the strategy needs to more clearly set out that physical and mental health are not just issues that sit alongside each other, but are closely interconnected. The physical health problems suffered by this group are closely bound up with their mental health issues, for example through the use of smoking as a coping mechanism for stress, anxiety and boredom. But although it is commonly used, smoking is a harmful and ineffective coping mechanism and so there is no trade-off where physical health problems are the price paid for alleviating mental health symptoms. Stopping smoking does not just improve physical health but is associated with reduced depression, anxiety and stress and improved positive mood and quality of life. The effect size seems to be as large as that of antidepressant treatment for mood and anxiety disorders. Furthermore stopping smoking can also lead to reduced dosage of psychotropic drugs and improved personal finances, each bringing further positive impact on mental health and well-being.
The second question asked if there were other actions we feel need to be taken. Again our view is that there is more that can be done.
It is not enough that prevention programmes, such as stop smoking support, are accessible to people with mental health issues – it could be said that such services are already available. To be effective such services must be both tailored to the particular needs of this group and in the right places where they will engage with them. In our recent focus groups people with lived experience called for services to be integrated with the mental health support they already engage with, rather than be separately located.
The contribution of this strategy to delivering on the Scottish Government’s goal of a tobacco-free generation should be clearly set out, and the mental health strategy must integrate with the next tobacco strategy (due in March 2018). To do this we will need some means of measuring smoking rates and behaviours amongst people with mental health issues in Scotland, so that targets can be set and progress measured.
Finally we were asked what we want mental health services in Scotland to look like in ten years’ time. ASH Scotland presented a number of suggestions for how the strategy needs to respond to the strong link between smoking and mental health:
Leadership – clear messaging at national/strategic level that smoking is part of the problem and should be addressed as part of the solution
Information – core information on smoking/mental health links made available in clear, user-friendly materials. This to include links between smoking, mental health and mortality, impact of stopping smoking on mental health, financial/social implications, impact on dosage of medications and other relevant information
Support for service users – stopping smoking as part of the support mix proactively offered to people. This should be clearly set out in service-level agreements, with stop smoking services to be tailored if provided in mainstream NHS settings, or provided in mental health settings themselves, including those in the third sector.
Training and guidance for staff – staff provided with the knowledge, understanding and skills to address smoking behaviours amongst the people they support
Raising the issue – every opportunity taken throughout the system to engage with smoking behaviours, including at GP and other health service appointments but also in wider life support such as finances or independent living.
Access to the full range of stop smoking aids and support for people with mental health issues who smoke, particularly when on appointment to smoke-free venues.