A 2022 report by Action on Smoking and Health (ASH) and the Royal College of Psychiatrists (RCP) demanded action to combat the high rate of people smoking among those experiencing mental health issues. The call is being made again by the UK’s Mental Health and Smoking Partnership due to a lack of action from mental health trusts. A key part of the action demanded is to encourage smokers to switch to vaping.
Are smoking rates higher among people with mental health conditions?
“Smokers with mental health conditions are observed to be more dependent than those without mental health conditions, consuming more tobacco and smoking earlier in the day,” ASH and the RCP point out.
“Smoking prevalence among people with a mental health condition is more than 50% higher than in the general population and accounts for two-thirds of the difference in life expectancy in people with a serious mental illness.”
Why don’t they quit?
The issue isn’t just that more people smoke, it’s also that they smoke harder and are more addicted to nicotine – meaning that quitting is harder.
The historical issue has been that mental health professionals believed the priority was to treat the presented conditions and that the patients’ smoking wasn’t a priority as it brought them comfort.
ASH and the RCP discovered that although 91% of trusts allowed vaping to take place, access to vape products varied considerably and was also banned for patients with certain conditions.
They called for trusts to “improve the skills and knowledge of professionals to enable them to motivate and support quit attempts”, pointing to a 2020 study by Brose, Brown, Robson, et al., in 2020 which found “smokers with mental health problems were more likely to show harm reduction behaviours including cutting down” by using e-cigarettes.
ASH and the RCP found that half of mental health nurses and most psychiatrists “had no training” to help smokers stop smoking and harboured many misconceptions about quitting and electronic cigarettes.
Was action taken to address the issues?
No. The crisis in funding for the mental health sector continued and little changed over the last 12 months.
The Mental Health and Smoking Partnership has issued a 7-point easy to digest plan to help professional staff improve the service they offer.
Who is The Mental Health and Smoking Partnership?
“The Partnership is a coalition of Royal Colleges, third sector organisations and academia”, including the likes of Cancer Research UK, the College of Mental Health Pharmacy, King’s College London, Mind, and the National Centre for Smoking Cessation and Training (NCSCT).
Point 1 – Talk to patients
Louise Ross, NCSCT Clinical Consultant and chair of the New Nicotine Alliance, says that staff should talk to all patients about their smoking status, “record the result in the patient’s notes, and provide them with NRT or a vape straight away. This should be done during the first face-to-face contact if possible.”
ASH says that over a third of smokers with a mental health condition think vaping is at least as harmful as smoking – if not more so – and believes talking to them is the only way to overcome the misconceptions.
Point 2 – The benefits of quitting
Ann McNeill, Professor of Tobacco Addiction at King’s College London and co-author of the Office for Health Improvement and Disparities’ vaping evidence update, believes all smokers need to be told about the benefits of switching to vaping regardless of their mental health status.
“Stopping smoking increases your chances of living a longer and healthier life and reduces the risk of heart disease, cardiovascular disease and respiratory disease.
smoking may lead to reductions in anxiety and depression at least as great as from taking antidepressants,” she said.
Point 3 – Mental health issues are not a barrier to conversations
Dr Peter Byrne is a Consultant Liaison Psychiatrist at the Royal London Hospital and a member of the RCP.
He points out: “There are still widespread myths about the negative impact of quitting smoking on mental health and perceptions that people with mental health conditions aren’t interested in quitting smoking. This couldn’t be further from the truth.”
“Smoking increases the risk of developing schizophrenia and depression and evidence shows that quitting smoking quitting smoking can lead to reductions in anxiety and depression at least as great as from taking antidepressants.”
Dr Byrne thinks that it is vital smokers experiencing mental health problems have conversations about their habit and the possibility of switching to vaping as not to do so can be seen as a “green light” to continue with tobacco.
Point 4 – Give the choice to vape
Vaping is now the most popular method of quitting smoking in England. A vape does not produce any carbon monoxide and the vapour doesn’t have any tar or most of the other toxic chemicals found in smoke. Those chemicals that are found in vapour are in substantially lower quantities.
King’s College London’s Dr Debbie Robson says: “Evidence shows that vaping poses a small fraction of the risks of smoking. E- cigarettes that contain nicotine are estimated to be around 60% more effective than NRT in supporting smokers to quit successfully.”
“Many mental health services are using them to help their patients quit smoking or temporarily abstain from smoking during an admission to a smokefree hospital.”
Point 5 – Embed experts
Dr Elena Ratschen thinks trusts should embed a quit smoking expert within every team so all patients can have access to evidence and facts about e-cigarettes.
“Evidence shows that behavioural support from a trained stop smoking practitioner combined with … e-cigarette use is the most effective way to help smokers with mental health problems quit,” she said.
Point 6 – Quitting is part of the care package
“If staff don’t take smoking seriously, then why should patients? We all have a duty to support our patients, improve their health and wellbeing and reduce health inequalities,” Drug Alcohol and Smokefree Lead Helen Philips said.
Point 7 – It’s all about creating an environment
“Being supportive is the best thing health professionals can do,” said Consultant Clinical Psychologist Moira Leahy. “Smokers should be provided with … e-cigarettes and given behavioural support.”
Ultimately, the uniformity in the supportive messaging about vaping from so many diverse public health experts is striking. Vapes have been shown to be “at least 95% safer than smoking” and work better than NRT as smoking quit tools – for smokers regardless of their mental health status.
“Each morning, afternoon, evening, day and week without smoking is an achievement to be recognised and celebrated,” concluded Moira Leahy, and vaping can make that happen.