World Mental Health Day was this week. The theme this year was ‘Investing in mental health’, so it was heartening to see the Department of Health and Comic Relief committed to giving £20 million to the next phase of Time to Change, England’s programme to tackle mental health related stigma and discrimination.
At any one time, one in six people in England will have a common mental disorder like depression or anxiety. As well as the emotional and psychological consequences, people with a mental disorder also experience higher rates of physical illness and lower life expectancy than the rest of the population. Some of this inequality may be explained by the fact that people with a mental illness smoke more than those without.
Findings from the Adult Psychiatric Morbidity Survey (APMS) 2007 showed that 33% of people in England with a mental disorder were ‘regular smokers’ (smoke seven or more cigarettes per week), compared with 22% of the general population. Although rates of smoking were higher among those with almost any of the mental disorders measured by the survey, rates were particularly high among those with probable psychosis (40%), alcohol dependence (46%) and illicit drug dependence (69%). 57% of people who had attempted suicide in the past year were smokers. And these figures are likely to be underestimates: APMS was a survey of people living in private households, so missed out some groups of people known to have higher rates of smoking, such as people living in mental health settings, those who are homeless or in temporary housing, and those in prison.
For some people living with mental illness, smoking may be regarded as a form of self-medication to alleviate symptoms. However, it also creates a financial and health burden on an already vulnerable group. Many people with mental health problems want to stop smoking, and could successfully do so if given the right support, and yet they are less likely to be offered smoking cessation services.
The NHS provides excellent general resources on quitting smoking, and the mental health charity MIND also has information on supporting people with a mental disorder to quit. Mental health professionals need to make sure that they routinely ask about smoking, and ensure specialist support is provided where needed. With 42% of all cigarettes smoked in England being smoked by people with a mental disorder, should the tobacco companies be addressing these issues, alongside the NHS and charities?