Smokers with mental health issues need more help

SMOKERS often worry that their habit is a coping mechanism they can’t do without, especially if they have mental health issues.

Vulnerable patients who give up smoking are more at risk, argues Sheila Duffy. Picture: PA

But quitting tobacco can actually help to relieve stress and lead to an improvement in the symptoms of anxiety, depression and other challenges to mental health.

Recent research, highlighted in The Scotsman and elsewhere, suggested that giving up results in similar improvements to mood and anxiety as you would expect from treatment with antidepressants.

However, tobacco use is a neglected epidemic in people with poor mental health. Their smoking rates are around twice as high as those for the general public, and even greater in those who suffer from more severe conditions. Those with mental health problemsd are less likely to succeed if they attempt to quit.

There seems to be a link between smoking and depression. Tobacco use is associated with an increased risk of depression, including postnatal, and people with the condition are more likely to become smokers. Some research suggests people with mental health issues light up as a kind of ‘self-medication’ to improve memory or reduce symptoms. But the reasons for the higher rates of smoking amongst people with mental health issues are complex and not yet fully understood.

However the lethal nature of smoking means that any perceived psychological benefits could be outweighed by the vast physical harms.

. Around 13,000 people die in Scotland every year from tobacco-related illness – a quarter of all deaths. The number of people with mental health issues among those is proportionately high.

People with schizophrenia have a 20 per cent shorter life expectancy than the general population and are more vulnerable to many conditions, including diabetes, coronary heart disease, hypertension and emphysema. These conditions can be caused or made worse by smoking so quitting can be a very positive step.

Constituents in tobacco smoke can effect some antipsychotic medications. When somebody stops smoking they can reduce their dose of the drug, potentially reducing the side-effects they experience. Treating tobacco dependence is worthwhile for people with mental health challenges and may be just as effective as for the general population.

Giving up won’t adversely affect mental well-being and will improve overall health. That’s a message we’re taking out to the community in several ways. Our tailored, free Tobacco Awareness-Raising Sessions, up and down the country, have been delivered at several organisations where the staff care for people with mental health issues. The more they know about the benefits of quitting for the people they look after, the better, so that they can discuss smoking and tobacco use with their patients and find out if quitting is something they’d be interested in.

While existing smoke-free legislation includes an exemption for designated rooms in psychiatric hospitals and psychiatric units, guidance has been issued to help the NHS move towards mental health care where indoor smoking is no longer permitted. The Scottish Government wants mental health services to ensure that all indoor facilities are smoke-free by next year (2015).

We’re actively promoting the message to hospital patients, through our work with staff, that stubbing it out makes sense. This month we’ll be visiting a couple of hospitals, giving expert training to mental health “ward champions”.

The staff taking part won’t become specialist stop-smoking advisors, but they will learn enough information about tobacco use and mental health to have a well-informed chat with patients and a good understanding of the quitting process.

The ward champions will get training on nicotine and addiction and learn about electronic cigarettes, which contain nicotine but not tobacco. They’ll then be able to give ongoing support, helping patients with withdrawal symptoms, coping strategies and tackling relapses.

After all, people who need support with their mental health shouldn’t be treated in a different way to other members of the public when it comes to looking after their physical health.

Smoking in mental health institutions perpetuates inequalities in the treatment of people there. They’re not able to smoke in public places when they live outside hospital, so having the option to smoke in mental health hospitals makes them appear different.

We’ve a duty to try and do more to help people experiencing mental health issues improve their physical health.

Along with an improvement in mental health, quitting can give patients an increased sense of self-esteem, lower their stress levels and free them from addiction to a lethal substance. And a drop in smoking in the work environment is good for the staff as they don’t want to be exposed to second-hand smoke and the associated harmful impacts it can have on their health.

We must challenge the myth that smoking helps people cope with mental health issues and make sure we address the health inequalities caused by the number of people with poor mental health who use tobacco.

• Sheila Duffy is chief executive of ASH Scotland

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