Guest Blog: The Mental Health and Smoking Partnership: Tackling Health Inequality

-Hazel Cheeseman, Action on Smoking and Health

There are many challenges in mental health services today but few feel more pressing than finding solutions to the stark difference in life expectancy between the users of these services and the population as a whole. In recent times there has been a growing movement to address the lack of parity in physical health outcomes, but while smoking rates continue to be double, if not more, among people with a mental health condition we face an uphill battle. Put simply, smoking is at the core of the health inequalities related to mental health. I am delighted that the Association of Mental Health Providers has become a key ally in the work to find a solution to this terrible inequality.

The evidence is clear that quitting smoking is the single best thing a smoker can do for their health. Contrary to the myths smokers with a mental health condition have as much, if not more, to gain from quitting as other smokers. The impact of quitting on mood and anxiety appears to be equal to, or larger than, that of antidepressant medications. Quitting has been associated with reductions in depression, anxiety and stress, as well as improved mood and quality of life. It can also reduce the necessary dose of some antipsychotic medicines. Reducing smoking prevalence is not an aim in itself – it is a clear, evidenced way of significantly increasing the health of patients.

In this context, the scope and scale of the partnership are very important. The mixture of organisations in the partnership – VCSE organisations, mental health trusts, Royal Colleges, among others – provides the opportunity to bring about meaningful and lasting change in both policy and practice.

At the start of the year the Partnership published a series of resources to support the work of anyone working to address smoking. In particular we published a set of key messages to promote understanding of both the impact of smoking on patients but also the solutions we can put in place to change this.

The document outlines six challenges that we face to be able to reduce smoking prevalence among people with a mental health condition, and thus reduce the health inequalities they experience. But The Mental Health and Smoking Partnership is optimistic that we can overcome these challenges and the document also sets out the seven areas where we can bring about change and transform rates of smoking.

Key challenges

1. High smoking rates – Smoking rates in England have been falling for some time, and were 15.5% in 2016. However, among mental health patients, smoking rates have barely changed over the last 20 years, stuck at around 40%. A third of all tobacco smoked in the UK is smoked by people with a mental health condition.
2. Leading cause of premature death – High rates of smoking are the primary cause of the shocking 10-20 year gap in life expectancy for people with a mental health condition.
3. Barriers to quitting – Two thirds of mental health patients who smoke want to quit, and 64% are worried about the impact of smoking on their health. Despite this, many report that they aren’t advised to quit.
4. Wide impact of smoking – Smoking negatively impacts mental and physical health, and can push people into poverty, making things worse.
5. Deep inequalities – People who experience multiple disadvantage, such as those with mental health conditions and experience of homelessness, drug abuse or alcohol problems, have higher smoking rates. Pregnant women with mental health conditions are also more likely to smoke than pregnant women in the general population.
6. Smoking myths – There are a number of myths that need to be dissolved. For example, the belief among many mental health workers that smoking can alleviate anxiety and distress, or that quitting can lead to violence and aggression. The evidence disproves these suppositions, yet they persist.

The changes we need

1. National leadership – We need implementation of the Tobacco Control Plan for England and a specific target to reduce smoking rates among people with a mental health condition.
2. Local co-ordination – Close and effective collaboration, and shared plans, are required between local authorities and the NHS.
3. Empowered and informed people – Service users must be empowered by public health and mental health services to take control of their own smoking, and must be included in the development of relevant services.
4. Trained staff – Mental health staff should receive appropriate training in smoking cessation, and smoking cessation specialists should likewise be trained in mental health.
5. Environments that support quitting – NICE Guidance PH48 should be fully implemented in all mental health trusts to treat tobacco dependency, alongside implementing smokefree grounds.
6. Alternatives for those who can’t quit – People who can’t quit should be offered information about a range of alternative nicotine containing products, including electronic cigarettes.
7. Better data and more research – More, and improved, data on smoking rates and service provision, closing the gaps in the evidence base.

Summary

Having outlined our messaging and strategy, it is important that our future actions are influenced by these.  The next step is to ensure that these messages are heard and that they inform the relevant policies and those who make them. Those who provide services directly to people with a mental health condition, The Association’s members have an important role to play. With your help we can reduce the shocking health inequalities that smoking causes among one of society’s most vulnerable groups. There are many useful supporting documents available on the Mental Health & Smoking Partnership webpage and you can get in touch with the Partnership by email. You can also download the shared key messages – the document also contains full references for information given in this article.