Breaking the tobacco taboo

5 April 2013

A recent report by the Royal College of Physicians and the Royal College of Psychiatry has examined the link between people with mental disorders and increased rates of smoking, concluding that the NHS's lack of smoking cessation treatment for this group is a significant factor in the early death of many of those living with a mental illness.

We have known for a long time that people with mental disorders are much more likely to smoke than those without. Research has shown that 40% of people with mental health problems are smokers compared with 20% of the population as a whole, and the incidence is even higher in people with schizophrenia, who are three times more likely to be smokers. There are a number of reasons for this disparity, not least the fact that many people with mental health problems smoke to ‘self-medicate’, feeling that smoking alleviates some of their symptoms - an illusion that we deal with elsewhere on our website.

But perhaps this disparity is better understood when considered alongside the fact that people with mental disorders are more prone to health risk behaviours in general, such as alcohol and drug misuse, self-harm and lack of physical activity. It’s not difficult to place smoking among these behaviours: nicotine-addiction is a form of drug abuse, a clear danger to physical health and, almost by definition, a form of self-harm – albeit a delayed and somewhat slow burning one. The difference is that if a person being treated for a mental health problem was heavily addicted to alcohol or drugs, or if a patient was self-harming, these things would likely be addressed as part of their treatment. But people who regularly smoke are, in a sense, both displaying behaviours of both addiction and self-harm, yet smoking appears to be acceptable. The danger is that smoking becomes perceived as simply an inevitable or irrelevant side effect of mental illness, something that isn’t even worth considering treatment for. This is both patronising and discriminatory, which people with mental health problems could do without. The Government did make the positive move of banning smoking on psychiatric wards a few years ago, but then failed to ensure adequate smoking cessation services were in place when people were discharged back into the community.

Of course, it’s important not to stigmatise people with mental disorders who choose to smoke, which is after all a legal, socially-acceptable activity. But it’s equally important to make it very clear that smoking cessation can improve both mental and physical health. Thus, framing it as a treatable addiction, rather than an unrelated habit or behaviour, can be a helpful exercise. Interestingly, the report showed that smokers with mental disorders are just as likely to want to quit as those without, but they are more likely to more addicted, to find smoking cessation more difficult, and to eventually give up.

We must, therefore, ensure that people with mental health disorders have proper access to smoking cessation services so that they have the support they need, should they make the choice to quit.