No butts – it's time to help people with mental health conditions quit smoking

November 7, 2018 by Ben Harris, Holly Beswick, Jenny Bowman And Kate Bartlem, The Conversation
People with a mental health condition are more likely to be smokers. Credit: shutterstock.com

Australians with mental health conditions are more than twice as likely to be smokers as the general population. About 22% of people with a mental health condition smoke daily compared to a national rate under 13%. And the more severe your illness, the more likely you are to smoke. For example, about 60-70% of people with psychotic conditions such as schizophrenia smoke.

We don't have clear evidence for why this is the case, but there are several theories. These include that people with mental conditions may smoke to self-medicate or to cope with social exclusion. People with mental health conditions are also more likely to have lower levels of education and higher levels of unemployment, which are accepted risk factors for smoking.

Despite huge gains in getting Australians to quit since the turn of the century (22% of Australians smoked in 2001), people with a mental illness appear to have been left behind. They are a big group to overlook. More than 4 million Australians are living with mental health conditions, including anxiety, depression and psychosis.

Why it matters

People with mental health conditions are at a much higher risk of chronic physical conditions, and more likely to die prematurely as a result. People with severe mental health conditions are at risk of dying from heart conditions and cancer 10 to 15 years earlier than the rest of the population. Smoking is undoubtedly contributing, being a key risk factor for heart disease, stroke, cancer and a range of other conditions.

Some health professionals may have put smoking in the "too hard basket" for certain patients with complex or urgent health needs. But there is good evidence people with mental illnesses want to quit smoking, that they are capable of quitting, and that smoking causes stress rather than relieving it. Research also shows quitting does not exacerbate poor mental health, but rather improves it.

Help people quit in hospital

Imagine a health professional telling you to keep smoking to help manage your disease. Until as recently as late last century, this was the case for some people being cared for in psychiatric facilities. There are even reports of patients entering hospital care as non-smokers only to be discharged later with the potentially lethal habit. While a culture of smoking is no longer encouraged in mental health facilities and hospitals, in some it is not actively discouraged.

People with severe mental health problems may spend time in an Australian hospital which is meant to be smoke-free. But are they really free of tobacco smoke? Despite nearly every Australian hospital having a smoke-free policy, we know implementation and enforcement have been patchy.

We need to do more to enforce smoke-free policies and use these as an opportunity to help patients quit. Research shows total smoking bans in mental health facilities help people quit when they are supported with appropriate nicotine-dependence treatment.

While a smoke-free environment will hopefully remove temptation, hospital stays also give health professionals an opportunity to discuss smoking with patients. This can include whether the patient wants to quit, how they want to do it, and what sort of therapies are available to help them with the process.

Post-discharge support is also crucial. All patients should be referred to services such as Quitline when they leave hospital.

Promote quitting in all mental health services

We know 4 million people with mental health conditions are much more likely to smoke, but only a small proportion of them need psychiatric hospital care. Other , including general practice clinics, should promote the benefits of quitting if they are not doing so already.

People with mental health conditions want to improve their physical health and address risk factors causing ill health. However, mental health providers often don't see this as their job while they concentrate on improving a patient's mental health.

Given we know quitting smoking will improve patients' mental health, it's important all services embed brief models of preventive care into their standard practice. Proven, effective strategies assess the patient's nicotine dependence, offer personalised advice and assistance, and provide referral to behaviour change supports. These strategies are simple and don't take much time.

A trial at a mental health service in New South Wales has offered mental health clients the opportunity to discuss their lifestyle with a nurse "coach" who gave advice and support for issues such as smoking, diet and physical activity. Evaluations of this model undertaken so far demonstrate it is popular with patients, inexpensive and can be effective.

We need to do better

People living with mental health issues are interested in improving their own physical health, but quitting smoking isn't easy. Just like everyone else, people with mental health conditions need help and support.

Despite this need, there is a reported unwillingness or ambivalence among some mental health practitioners to address risk factors such as smoking among their patients, and there is no systematic approach in services to provide support to quit smoking.

Health practitioners and services have a critical role to improve health overall. Helping people to stop smoking is still the best thing we can do to support a longer, healthier life.

The fifth National Mental Health Plan, as well as state and territory plans, call for more action to prevent early death and chronic disease among people with . Combating is essential to achieving this goal, and should be incorporated into the provision of care for this population at all levels.

Explore further: Quit rates are low and not increasing among cigarette smokers with mental health problems

Related Stories

Quit rates are low and not increasing among cigarette smokers with mental health problems

November 1, 2018
Even as more and more American quit smoking cigarettes, individuals with serious psychological distress (SPD) are much less likely to extinguish their habbit. A new study by scientists at the Columbia Mailman School of Public ...

Little 'quit-smoking' help at U.S. mental health centers

May 10, 2018
(HealthDay)—Many mental health and addiction treatment centers in the United States don't help patients quit smoking, a new government study finds.

Vaping should be part of support to help smokers with mental health conditions quit

November 16, 2017
A group of health bodies and charities has called for more to be done to help smokers with mental health conditions quit, including accessing e-cigarettes and other treatments.

Should psychiatric hospitals ban smoking completely?

November 4, 2015
In The BMJ this week, experts discuss whether hospitals should ban smoking for psychiatric patients outside as well as indoors.

Stroke, cancer and other chronic diseases more likely for those with poor mental health

August 8, 2018
Four million Australians, including our friends, family members, co-workers and neighbours, are living with mental health conditions, including anxiety and depression.

People with mental illness make up large share of US smokers

March 20, 2013
(HealthDay)—Adults with a mental illness or a substance-abuse disorder represent about 25 percent of the U.S. population but account for nearly 40 percent of all cigarettes smoked in the country, according to a new study.

Recommended for you

New exercise guidelines: Move more, sit less, start younger

November 12, 2018
Move more, sit less and get kids active as young as age 3, say new federal guidelines that stress that any amount and any type of exercise helps health.

Some activity fine for kids recovering from concussions, docs say

November 12, 2018
(HealthDay)—Children and teens who suffer a sports-related concussion should reduce, but not eliminate, physical and mental activity in the days after their injury, an American Academy of Pediatrics report says.

Yelp reviews reveal strengths and weaknesses of emergency departments and urgent care

November 9, 2018
Yelp reviews reveal that emergency departments are viewed as being higher quality but lacking in service as compared to urgent care centers, which patients rate the opposite, according to a new study from researchers in the ...

A look at how colds and chronic disease affect DNA expression

November 8, 2018
We're all born with a DNA sequence that encodes (in the form of genes) the very traits that make us, us—eye color, height, and even personality. We think of those genes as unchanging, but in reality, the way they are expressed, ...

Patients with untreated hearing loss incur higher health care costs over time

November 8, 2018
Older adults with untreated hearing loss incur substantially higher total health care costs compared to those who don't have hearing loss—an average of 46 percent, totaling $22,434 per person over a decade, according to ...

Drug overdose epidemic goes far beyond opioids, requires new policies

November 7, 2018
Most government-funded initiatives to address the overdose epidemic in the United States have targeted opioids specifically and have neglected other drugs that are increasingly implicated in overdoses, such as cocaine and ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.