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Key points
Smoking rates in people who have mental illness is 50% higher than the general population.
Evidence suggests there is a positive correlation between smoking and mental health conditions, but whether there is a causal link remains unclear.
Encouraging mental health patients to quit may not be so straightforward on both an individual and public health level.
Smoking is the leading cause of preventable premature death and morbidity, creating a large burden on an already struggling NHS. The incidence of smoking has declined steadily in the general population over the last few decades but has remained stubborn in those with mental illness. In the UK, one third of those with a mental illness smoke, according to the BMA. There is a need for evidence on the link between smoking and mental health as this will guide cessation programmes and hopefully improve quality of life for these patients.
On the one hand, smoking may influence mental health disorders: a systematic review of the literature shows that smoking enhances the progression of bipolar disorder. On the other hand, mental health problems may predispose someone to smoking. It is commonly believed that smoking is a form of self-medication: a cigarette may be used to allay stress. At Polygeia, we are exploring the positive correlation between smoking and mental illness with a systematic review: does smoking cause mental health problems or vice versa?
Smoking cessation will improve physical health in these patients thus is worthwhile, but knowing about the correlation could help guide cessation on an individual level. For example, if smoking improves mental health even in the short term, quitting will be more difficult and implementation plans will have to take this into account.
Although many psychiatrists think smoking cessation could adversely affect mental health conditions, the majority of studies suggest quitting could actually help. However, it seems implementation is currently lacking: the charity Action on Smoking and Health (ASH) asked smokers with mental health problems whether there had been any help provided to them to stop smoking and two thirds hadn’t been offered it. Many of those who had stated that help with quitting wasn’t effectively managed. Therefore, there is a need for evidence and, at Polygeia, we will explore whether smoking cessation adversely affects mental health.
Smoking cessation is a complicated issue for public health intervention. Some worry cessation could cause an increase in the incidence of physical violence towards mental health workers thus impede implementation of policy measures.
There have been several smoke-free trials in hospitals throughout the UK, including Aberystwyth, Pembrokeshire and the South London & Maudsley Trust. Overall, all three trails were successful in both smoking cessation rates and outcomes for patients. Furthermore, the trial in inpatient wards in the South London & Maudsley Trust showed the incidence of violence actually decreased by 39%, contrary to worries held by staff. Therefore, at Polygeia we are synthesising the aspects that worked well across these trials to create policy recommendations for replication elsewhere.
The physical health of mental health patients is sometimes overlooked. However, helping patients with smoking cessation could have holistic benefit for physical and mental health and help equalize life expectancies between these patients and the general population. Evidence is needed to guide cessation policies and our results will be available in Autumn 2018.
Further viewing/reading
About the author
Fourth year medic interested in mental health and psychiatry. Likes orangutans and dislikes Trump.
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