Stolen years: how smoking disproportionately harms those with mental health conditions

People with mental health conditions die on average 10-20 years earlier than the general population and smoking is the single largest factor in this shocking difference. Around one third of adult tobacco consumption is by people with a current mental health condition ¹ with smoking rates more than double that of the general population ². People with a mental health condition are just as likely as other smokers to want to quit, but because they are more likely to be heavily addicted to smoking, they need more support to be successful. Support which is currently lacking.

A new report from Action on Smoking and Health (ASH) and endorsed by 27 health and mental health organisations³ sets out recommendations for how smoking rates for people with a mental health condition could be dramatically brought down over the next few years.

Paul Burstow, former Health Minister and Chair of the Tavistock and Portman Mental Health Trust and chair of the report said:

"It is time to challenge the idea that smoking amongst people with mental health conditions is either inevitable or intractable: it is not. With a determined and collective effort we can save millions of people from early death and avoid years of life being blighted by heart and lung diseases, stroke and cancer."

The report sets out the urgent action needed to get smoking rates falling in this population. There is no single measure that will achieve this but change is needed in all parts of the health and social care system from national government through to local authorities, the NHS and care providers. Key areas for action are:

• National targets and leadership to drive action across the country
• Strong focus on the skills and training of the workforce
• Availability of evidence-based services alongside peer support for all those who need them
• Better access to the medications that will help people to quit
• Improved understanding that electronic cigarettes provide a less harmful alternative to smoking
• Moving to smokefree mental health settings alongside provision of the right support to smokers

Professor Sir Simon Wessely, President of the Royal College of Psychiatrists said:

"The Royal College of Psychiatrists is committed to improving the physical health of those in our care, and tackling smoking high rates of smoking will be fundamental to our success. Like any decent doctor we do not think we can just sit back and watch people smoking themselves to death without doing the best we can to prevent this"

Brian Dow, Director of External Affairs, Rethink Mental Illness said:

"We know that people with a mental health condition are just as likely to want to stop smoking as other smokers. But this can be much harder if, for example, you are using smoking as a coping mechanism. This is why people need specialised, longer term support. 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."

Smoking not only affects people's health but also their wealth. New research conducted by the University of Nottingham for this report shows the contribution smoking is making to pushing people with a mental health condition into poverty. It estimates that a million people with a 'common mental health condition' are living in poverty and smoke, and a further 130,000 are pushed into poverty once their spending on tobacco is taken into account ⁴.

Deborah Arnott, Chief Executive of ASH said:

"The appalling gap in life expectancy between those with a mental health condition and the general population is unacceptable. Not only are high rates of smoking contributing to a widening gap in health, but also in wealth, with thousands of people pushed into poverty due to their expenditure on tobacco. To reverse these trends professionals in every part of the health and social care system must work together."

In response to the report from ASH, 'The Stolen Years: The Mental Health and Smoking Action Report,' Dr Max Davie, of the Royal College of Paediatrics and Child Health, said:

"Today's report highlighted that a third of all tobacco now smoked in England is by someone with a mental health condition, some of whom are parents or women pregnant with a child.

"We know that children who are exposed to smoke in the womb are at increased risk of being still born, being born prematurely and at increased risk of conduct disorder and ADHD symptoms as they get older. Children who live or socialise with people who smoke are more likely to light up themselves, putting them at significant risk of developing serious health problems later in life such as cancers, heart disease, heart attacks, pneumonia and emphysema.