Urgent international action is needed to address the ‘unseen epidemic’ of tobacco-related deaths among people with mental health issues, say researchers from the University of York. People with conditions like depression, bipolar disorder or schizophrenia are around three times more likely to smoke than the general population, shortening life expectancy by up to 20 years.
Although tobacco use is decreasing across the world it remains ‘persistently high’ among people with mental health conditions, says the study published in the New England Journal of Medicine. ‘Some mental health care workers see smoking as inevitable in their patient population, and believe that attempts to help patients quit are futile,’ the researchers state, highlighting a ‘therapeutic nihilism’ – the belief that no intervention can work. ‘But many people with mental illness who smoke want to quit and can successfully do so.’
People with mental health conditions are often more heavily dependent on nicotine than other people, experiencing ‘more intense cravings and withdrawal’, the study says, with clinicians often believing that quitting could destabilise their patients’ mental health. ‘Therapeutic pessimism remains common, and the physical health care offered to people with severe mental illness, including care for tobacco dependence, is generally suboptimal,’ it continues, adding that mental health and smoking cessation services often remain ‘siloed’.
However, the study highlights findings from the SCIMITAR+ trial, which tested a smoking cessation programme for people with mental ill health that offered tailored support and enhanced levels of contact. Designed in partnership with people who use mental health services and now being rolled out across the NHS, the programme ‘helped people to quit safely and effectively, without any disruption in their mental health’ and ‘providing a clear blueprint for health systems’, the study says.
‘The SCIMITAR+ findings show that tailored support works,’ said Professor Simon Gilbody of the University of York’s Department of Health Sciences. ‘Health systems should provide interventions responsive to the needs of people using mental health services. The tools to save lives are already here, and it is now urgent that we start using them.’
The York team is now also scaling up the work internationally through the SCIMITAR-South Asia programme, funded by the National Institute for Health and Care Research (NIHR). Almost 80 per cent of tobacco users are in low- or middle-income countries, which ‘face high burdens of both mental illness and tobacco-related diseases’, the report says. A recent WHO document stated that almost one in five adults worldwide were still addicted to tobacco, ‘fuelling millions of preventable deaths’, although the number of global tobacco users had fallen from 1.38bn to 1.2bn over the last 25 years.
‘What we need is evidence solutions and our latest trials show what those solutions are and just how quickly they can work,’ said Gilbody. ‘These aren’t expensive solutions either. In fact they save money by preventing the harms that tobacco causes and they can be delivered by mental health professionals with the right training. It is important to recognise that there is not one solution that fits all, and health practitioners are best placed to know exactly how to tailor smoking interventions to the needs of their patient.’
A briefing paper from the Global State of Tobacco Harm Reduction (GSTHR) last year stated that social workers should be given the tools to promote tobacco harm reduction as they’re often the ‘initial, and in some cases, only’ point of contact with a range of marginalised communities, including those with significant mental health issues.
According to the most recent NDTMS figures published earlier this month, nearly half of people in drug and alcohol treatment were smokers – compared to 12 per cent of men and 9 per cent of women in the general population – while just under 75 per cent also reported having mental health treatment needs.
The epidemic of tobacco harms among people with mental health conditions available here
Smoking cessation intervention for people with severe mental ill health: SCIMITAR+ trial available here