Surviving or Thriving? Mental health awareness week Reply

For this blog post, ASH Scotland’s Chief Executive, Sheila Duffy, writes for us about smoking and mental health. This year’s Mental Health Awareness week runs from 8th to 14th May, with a theme of “Thriving or Surviving?” The organisers should be congratulated for seeking to look beyond poor mental health and to stimulate a discussion on what can make us well and help keep us well. I was especially drawn to the focus on “what steps we can take to look after our mental health, building resilience to cope with the demands of life?”

This recognition of the role of resilience goes to the heart of why mental health is so important to ASH Scotland’s work to reduce the harm and inequality caused by smoking. We ourselves may not be the best placed to help reduce the pressures, stresses and strains in life which contribute to mental ill health. We do, however, have something important to say about smoking as the coping mechanism that so many people automatically reach for.

I am not at all surprised that people reach for a cigarette at times of need. The public image of smoking has moved on from the glamour and sophistication of the golden age of Hollywood. Smoking still features prominently in the media, but is now often used as shorthand to signify someone in distress, sucking in relief through a tobacco straw.

Personal experience often reinforces this image. Whatever complicated morass of deep breaths, concentration, familiar routine and relief of nicotine cravings is actually taking place, the take-away memory will be that smoking has helped relieve stress.

Finally there is the extraordinary ease of access to cigarettes. Six decades after the proof that smoking kills, and for all the talk of tough government restrictions on smoking, cigarettes remain ubiquitous in our society, sold without license in every corner shop, garage and supermarket at an average price of 35 pence each. Imagine a world where other, less harmful, coping mechanisms were as visible and readily available?

And let’s be clear that, whatever the immediate impression, smoking is harmful to mental health as well as to physical health. It is easy to be misled by the apparent calming effects, but it should come as no surprise that the psychological boom-bust of nicotine cravings does not enhance overall mental well-being. Nor does the financial cost, or being out of breath or in pain, contribute to reducing anxiety. The fact that smoking limits the effectiveness of many medications, leading to increased dosage and side effects, was the chief concern expressed by mental health services users we recently consulted with.

We now know that stopping smoking is associated with improved mental health. Most people with mental health issues who smoke say they want to stop, so shouldn’t those people be offered stop smoking support as quickly and easily as psychotropic medications?

We do have work to do in exploring and developing the alternative, less harmful, coping mechanisms that can help people build resilience in the face of their problems. Yoga or mindfulness may be great, but only if you are someone who will do yoga or mindfulness. For others it might be knitting, computer games, an e-cigarette, walking, Facebook, or phoning a friend.

Every individual’s situation is different, the needs they are trying to address will be different, and the alternatives to smoking that might work for them will be different. What could make the difference is a conversation, centred on the individual, their needs, and the approaches available for them to consider and try.

This thinking forms the basis of the new IMPACT guidance ASH Scotland has produced for community-based mental health services. If a client is interested in talking about their smoking we recommend the AID approach – Ask, Inform, Discuss – and our guidance provides the background information and options to help staff engage in this way.

That kind of discussion takes time, but support staff already have the skills. Smoking is the biggest contributor to people with mental health issues dying 10-20 years earlier than the general population. Surely it merits a conversation?

This blog post originally appeared as a Friends of The Scotsman piece, which can be found here.

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