Smoking and mental health
With the Government’s goal for England to be smokefree by 2030 looming, the need to focus on supporting groups with higher-than-average smoking rates is abundantly clear. Those living with a long-term mental health condition are twice as likely to smoke, with the likelihood rising the more severe their condition is.
Mental illness sufferers are twice as likely to smoke
Mental health conditions can range from common conditions like depression and anxiety, to severe conditions like schizophrenia and bipolar disorder. Smoking rates within this group have declined in line with the overall smoking rates in England but have remained extremely high in comparison.
Data from Public Health England shows that around 25% of those with anxiety and depression are smokers, and that rises to 40% for those with a severe mental health condition.
People with poor mental health have a life expectancy of 10 – 20 years less than the general population, and smoking is the biggest cause of this disparity. Public Health England estimates that a third of all cigarettes smoked in England are smoked by people with a mental health condition, and not only is smoking prevalence higher, but there is also a higher level of dependency. Even common conditions like depression and anxiety are associated with a greatly likelihood of being a smoker.
‘‘Staying quit’ is associated with greater happiness’
There is a common misconception that smoking relieves anxiety and depression, leading some to believe that a quit attempt could be detrimental to their mental health. This is because smoking cigarettes can interfere with some of the chemicals in the brain, and nicotine cravings can make you feel irritable and anxious. When you smoke, these cravings are satisfied and the feelings will temporarily go away, so it is easy to associate this improvement in mood with smoking.
However, the opposite is actually true as stopping smoking can improve both physical and mental health. A review by the UK Centre for Tobacco and Alcohol Studies found that quitting smoking was associated with reduced depression, anxiety, and stress, with a similar effect to those offered by antidepressants. Public Health England advise that ‘although tobacco withdrawal can reduce happiness in the short term, ‘staying quit’ is associated with greater happiness.’
Tobacco smoke can also interact with some psychiatric medicines and make them less effective, often requiring an increase in dosage. Those who reduce or completely eliminate smoking will often be prescribed lower doses than those who remain heavy smokers.
RCPsych endorse e-cigarettes for mental health patients
It has been recognised that smoking rates remain high among those living with mental health conditions and that tackling this inequality is a core challenge in the years ahead if England is to reach the goal of being smokefree by 2030.
The NHS has committed to offering funded stop smoking services to all inpatients, including those being treated for mental illness, as well as high-risk outpatients. As advised by Public Health England, this will include the option to switch to an e-cigarette while in an inpatient setting.
E-cigarettes are now widely used in mental health facilities, but their use is limited in a variety of ways between different facilities. 47% of surveyed trusts allowed all types of e-cigarettes to be used, however 31% only allowed the use of disposable devices which cannot be recharged or refilled. 44% allowed the use of e-cigarettes indoors, while 72% allowed them in ward courtyards.
The Royal College of Psychiatrists (RCPsych) released a statement encouraging psychiatrists to advise patients who smoke about the safety of e-cigarettes relative to smoking, and that facilities should have policies in place that facilitate the safe and effective use of e-cigarettes.
At a glance
·People with poor mental health die on average 10 – 20 years earlier than the general population, smoking is the biggest cause of this life expectancy gap
·People with a long-term mental health condition are twice as likely to smoke, and the likelihood increases the more severe the condition
·A review by the UK Centre for Tobacco and Alcohol Studies found that quitting smoking was associated with reduced depression, anxiety, and stress, with a similar effect to those offered by antidepressants
·The Royal College of Psychiatrists endorse e-cigarettes to help those living with mental health conditions to quit smoking