World No Tobacco Day: Smoking and Mental Illness

01/06/2016 15:00

Here is a not particularly controversial fact: smoking is bad for you. Well, you would think so.

In the field of mental health, however, smoking is a remarkably divisive issue. Whenever we post something on our social media channels about smoking cessation in mental health services, it triggers a river of deeply held and often remarkably varied responses.

Some people posting will say with great conviction and, frankly, considerable persuasiveness, that alongside being severely mentally ill, with all that can bring, smoking is the one luxury that they do not want to do without. It's not difficult to imaging why, for someone who is so seriously ill that they may have to be admitted to an acute mental health setting, the notion of having to kick an addiction while receiving treatment, is all too overwhelming. Many others claim, however, that giving up smoking was the best thing they ever did for their mental, and indeed physical, health.

Both stances are reasonable and valid but what really is beyond discussion is that those with severe mental illness die, on average, 20 years earlier than the general population, and smoking plays a huge part.


People with mental health conditions typically smoke at higher rates and are more heavily addicted than average. Around one third of adult tobacco consumption is by people with a mental health condition. This means that they are much more likely to experience serious health conditions, such as cancer and heart disease, as a result of smoking.

And while smoking rates among the general population have been steadily declining over the last 20 years, for people with mental health conditions they have barely changed.

This remains a stubborn problem to which there are no easy answers.

What we do know is that action is urgently needed. This is perhaps the most glaring example of how people with mental illness's physical health is neglected and blighted by low expectations.

A new report launched recently by Action on Smoking and Health (ASH), and endorsed by Rethink Mental Illness and other health charities, sets out recommendations for tackling this complex issue. The report also looks at how smoking rates for people with a mental health condition could be dramatically reduced in the next few years.

Quitting smoking does not exacerbate poor mental health. In fact the positive impact of smoking cessation on anxiety and depression appears to be at least as large as antidepressants.

We know that people with a mental health conditions are just as likely to want to stop smoking as other smokers, but they find themselves facing complex and challenging barriers to quitting. One thing we hear a lot is that people use smoking as a coping mechanism for dealing with the stresses of having a mental illness. Some find it to be a useful distraction from other harmful behaviour, or even just an excuse to go outside.

The challenges are different for everybody. Reasons for smoking and reasons behind a struggle to quit are as individual as the person, and what works for some people won't work for others. This is why people need plans for quitting that are tailored specifically to them.

One thing that can help is making mental health services smoke free, although this has to be done alongside the right support to help people quit.

At Rethink Mental Illness we have been trialling a new intervention in mental health services to make sure people are fully supported to stop. This includes staff training and improved information about smoking cessation, produced in collaboration with people affected by mental illness. The first results from this project are expected later this year.

There is no quick fix for smoking and mental health. We need to work across mental and physical health services, and social care, to empower people to become smoke free, not because they are forced to but because they can see the benefits and because they want to.

You can find more information on smoking and resources for becoming smoke free on the Rethink Mental Illness website.