7 January 2020: Smokers with mental health conditions who successfully quit call on health professionals to do more to help others do the same
This new year, five people who use mental health services shared their inspiring quit smoking journey, to show that stopping smoking while experiencing a mental health condition can be done. The videos of their stories, produced by Action on Smoking and Health (ASH), the University of Bath and the University of York are available online (links below).
Nearly a third of smokers in the UK have a mental health condition, and a similar proportion of adults with a mental health condition smoke – this is substantially higher than the rate among the general population. [1] [2] Smoking is also associated with an increased risk of major depression and other mental health conditions, and there is strong evidence that smoking could be a cause of mental illnesses like depression and schizophrenia. [3] [4] [5]
Too often people with mental health conditions are discouraged from trying to quit smoking by health professionals. Yet smoking is the largest single contributor to the 10-20 year reduction in life expectancy among people with mental health conditions compared to the population as a whole. [6] [7] [8] There is also good evidence showing people should try and quit smoking if they have a mental health condition, and the new year is a good time to set quitting as a personal goal to improve health. [9]
The videos feature five people with mental health conditions and cover themes of anxiety, depression, schizophrenia and eating disorders. They show how people with mental health conditions can quit smoking with the right support, and how much quitting smoking improved their lives and wellbeing.
Some of the people in the videos took part in the groundbreaking study ‘SCIMITAR trial’, where they were offered a support package specifically designed for people who use mental health services. Led by the University of York, the SCIMITAR trial showed that, with support, smokers with mental health conditions could double their chances of successfully quitting [9]. However, all too often smokers with mental health conditions aren’t being given the help they need to quit.
Population studies show that quitting smoking is linked to improvements in mental health equal to taking anti-depressants [10]. Based on these findings, Dr Taylor at the University of Bath is working with NHS psychological services to integrate smoking cessation treatment as part of routine care for depression and anxiety for people who want to quit smoking. [11]
Video excerpt – Caroline, based in London:
“I remember saying to my psychiatrist that I wanted to quit smoking… I was constantly smoking as there was nothing else to do. He said, ‘let’s just do one thing at a time’. So, let’s get my mental health under control and then look at quitting smoking. That for me was the green light to keep on smoking.”
Video excerpt – H. Khan, based in Birmingham and Manchester:
“The mental health system fails in the sense that it tries to deal with one issue as the main one. A more holistic approach needs to be taken because sometimes everything is interconnected. I was being helped with my mental wellbeing but was still chain smoking, so I felt more depressed and got more unwell. I think the services have to work together in more of a joint approach.”
Deborah Arnott, CEO, Action on Smoking and Health (ASH) said:
“At the turn of a decade we are encouraging smokers to try a new year quit attempt to help improve their mental and overall health. Mental health staff have a pivotal role to play and they should take every opportunity to help their patients quit. The ex-smokers in the films show that people with mental health conditions can quit smoking with the right support, but also that all too often that support is lacking.”
Professor Simon Gilbody, Director of Mental Health Research at the University of York who led the SCIMITAR study said:
“These stories are inspiring, and we now have high quality evidence to show that it is possible for people who use mental health services to quit smoking. The benefits are enormous. People feel better, and they have more money when they are able to quit. Our message is that you should ask for help, since supported quit attempts are more likely to be successful. Unfortunately, many people who use mental health services are not told about the benefits of quitting. We hope these videos will help to ‘start the conversation’, since it’s never too late to give up.”
Dr Gemma Taylor of the University of Bath’s Addiction & Mental Health Group added:
“We know that people with mental health conditions are more likely to smoke and we know too that smoking is associated with increased challenges to their mental health. These new videos with the results from clinical trials and cohort studies [10] show that this does not need to be the case. For those starting 2020 with a positive resolution to kick the habit, it’s important to know that this is possible, and that help is at hand.”
View the videos here:
Caroline’s story: https://www.youtube.com/watch?v=J5DZDWbziCI&feature=youtu.be
Hameed’s story: https://www.youtube.com/watch?v=hDd2kFFVBFY&feature=youtu.be
El’s story: https://www.youtube.com/watch?v=edwFeXvANzc&feature=youtu.be
Paul’s story: https://www.youtube.com/watch?v=NVAIW6nC37Q&feature=youtu.be
Julian’s story: https://www.youtube.com/watch?v=rYFGx4hZ5t0&feature=youtu.be
ENDS
Notes to the editor:
[1] The Royal College of Physicians. Smoking and mental health. March 2013
[2] NHS Digital. ‘Smoking rates in people with serious mental illness’. 2016. Available at Public Health England Tobacco Control Profiles.
[3] Hamalainen J, et al. Cigarette smoking, alcohol intoxication and major depressive episode in a representative population sample. JECH 2001; 55: 573-76
[4] Klungsoyr O, Nygard JF, Sorensen T, Sandanger I. Cigarette smoking and incidence of first depressive episode: an 11-year, population-based follow-up study. Am J Epidemiol. 2006; 163(3): 421-32
[5] Taylor, G, Munafo, M, Does smoking cause poor mental health?, Lancet Psychiatry. 2019 Jan;6(1):2-3. doi: 10.1016/S2215-0366(18)30459-0. Epub 2018 Dec 5
[6] Royal College of Psychiatrists. Primary Care Guidance on Smoking and Mental Health Disorders. 2014.
[7] Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry 2014; 13(2): 153–160
[8] Chang CK, et al. Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London. PLoS One. 2011; 6(5): e19590
[9] Gilbody S, Peckham E, Bailey D, Arundel C, Heron P, Crosland S, Fairhurst C, Hewitt C, Li J, Parrott S: Smoking cessation for people with severe mental illness (SCIMITAR+): a pragmatic randomised controlled trial. The Lancet Psychiatry 2019, 6:379-390. [Free access here]
[10] Taylor, G et al, Change in mental health after smoking cessation: systematic review and meta-analysis, BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1151 (Published 13 February 2014)
[11] Taylor, G., Aveyard, P., Bartlem, K. et al. IntEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety (ESCAPE): protocol for a randomised and controlled, multicentre, acceptability, feasibility and implementation trial. Pilot Feasibility Stud 5, 16 (2019) doi:10.1186/s40814-018-0385-2
16 August 2018: Coalition welcomes MPs recommendations on e-cigarettes
The Mental Health & Smoking Partnership [1] today welcomes The Science and Technology Committee’s recommendation [2] that mental health services should better integrate e-cigarettes into care for patients.
The Partnership provided evidence to the Committee [3] on the significant inequality in smoking rates between people with a mental health condition and the rest of the population. People with a mental health condition are twice as likely to smoke, a major cause of their lower life expectancy and higher level of poor physical health.
In line with this evidence the Committee’s report notes that e-cigarettes offer great potential to address these inequalities and provide an alternative to smoking for an often highly addicted group of smokers.
In exploring the role of e-cigarettes in mental health services the Committee has found that a third of mental health trusts currently completely prohibit their use. The Partnership supports the Committee’s calls for NHS England to provide clear advice to Trusts to support increased integration of e-cigarette use into care settings.
Professor Ann McNeill, Co-Chair of the Partnership and Professor of Tobacco Addiction in the National Addictions Centre at King’s College London said:
“The Committee rightly highlight the urgent need for better support for smokers within mental health services. For too long services have been complacent about smoking among mental health patients and not provided enough support to help smokers become smokefree. A more evidence-based and consistent approach to e-cigarettes would be an important step forward, helping smokers to see that there are much less harmful alternatives for them. Trusts should ensure that all smoking cessation treatments are available and accessible to smokers.
"Trusts that allow the use of e-cigarettes have had a positive experience, with smokers welcoming the chance to make a positive choice to improve their health.”
The Partnership also welcomed the Committee’s recommendations to improve the medicinal licensing process for e-cigarettes. Products available on prescription would remove cost as a barrier to use and would give the public greater confidence in the devices.
The Committee further highlighted the important role of NHS England in addressing smoking rates across all services but particularly for people with a mental health condition.
Hazel Cheeseman, Director of Policy for Action on Smoking and Health who provide the secretariat for the Partnership said:
“Having e-cigarettes on prescription could be transformative. It would reassure staff that these products can help smokers and provide confidence to smokers themselves. However, Trusts should not wait for licenced medicines. They can confidently advise smokers to make the switch today.”
ENDS
Notes and Links:
To organise an interview with members of the Partnership contact ASH on 020 7404 0242 or out of hours Hazel Cheeseman on 07754 358 593.
References
[1] The Mental Health and Smoking partnership is a coalition of health organisations. A full list A full list of Mental Health & Smoking Partnership members can be seen at https://smokefreeaction.org.uk/smokefree-nhs/smoking-and-mental-health/mental-health-and-smoking-partnership-members/
For more information about the Partnership see here: https://smokefreeaction.org.uk/smokefree-nhs/smoking-and-mental-health/
[2] Science and Technology Committee Report on E-Cigarettes https://www.parliament.uk/business/committees/committees-a-z/commons-select/science-and-technology-committee/inquiries/parliament-2017/e-cigarettes-17-19/
Specific recommendation relating to mental health: “NHS England should set a clear central NHS policy on e-cigarettes in mental health facilities which establishes a default of allowing e-cigarette use by patients unless an NHS trust can show reasons for not doing so which are demonstrably evidence-based. NHS England should issue e-cigarette guidance to all NHS mental health trusts to ensure that they understand the physical and mental health benefits for their patients.”
[3] Mental Health & Smoking Partnership written evidence to the committee: http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/science-and-technology-committee/ecigarettes/written/75317.html