Mental health facilities to be smoke free
On 1 July 2008, it became a legal requirement for all mental health facilities to be smoke free. This presents a particular challenge since smoking prevalence among people with mental health problems is far greater than that of the general population: 44% of the total cigarettes smoked in a nationally representative sample were by those with a mental illness.
Smoking tobacco is significantly associated with increased prevalence of all major psychiatric disorders, with smokers twice as likely to suffer from a mental health problem than non-smokers and more likely to commit suicide.
People with mental illnesses are likely to be heavier, more dependent smokers and have smoked longer than smokers in the general population. In a large population survey of psychiatric morbidity in the UK, 64% of those with probable psychosis were smokers compared with 29% without psychosis. The highest levels of smoking occur within psychiatric in-patient settings, where up to 70% of patients are smokers and 50% are heavy smokers. Such high levels of smoking increase the amount of smoking-related harm people with mental health disorders suffer. It is responsible for a large proportion of the excess mortality of people with mental health problems. The death rate from respiratory disease among people with schizophrenia, for example, is ten-fold compared with the average. It is therefore crucial that people with mental health problems should have appropriate access to stop smoking support and be encouraged to stop.
Positive effects of intervention
Evidence suggests there is a link between the amount smoked and the number of depressive and anxiety symptoms.106 On stopping, these symptoms are seen to reduce
although a minority of people with depression who stop smoking experience an increase in depressive symptoms.
In people with schizophrenia, however, there is little evidence to show any worsening of symptoms following stopping smoking.109 Stopping smoking can result in significant reductions in the dosages of mental health medications and reducing doses will reduce the long-term consequences such medication can have.
Supporting people with mental health problems in stopping smoking can therefore have a direct impact on reducing health inequalities. However, health inequality experienced by people with mental illness will widen if investment in smoking cessation services for this group is not greater than for the general population.
Making access to smoking cessation services easier for those with disability due to severe mental disorder will also comply with the Equality Act.
