Guest post: Smoking in people with mental health issues

We recently spotted an interesting-looking paper on smoking and mental health, so we asked Suzi Gage – an expert in addiction and mental health who writes for Guardian’s Science Blog – to have a look. Here’s what she has to say:

People with mental health problems are more likely to smoke, and smoke more heavily, than the general population, and they’re often overlooked when it comes to offering help to quit.

The economic cost of smoking in people with mental health problems was £2.34 billion in 2009/10 in the UK, according to a new study published in the journal Tobacco Control last week. The authors suggest that this economic burden of smoking in mental health populations further supports the ethical argument for improving the ‘stop smoking’ services available for people with mental health problems, and that research in to tailored treatments for these smokers is urgently needed.

The study used economic models to look at direct and indirect costs to the NHS, and to the UK economy more generally. Even taking in to account the fact that people with mental health problems are less likely to be in work than the general population, and earn less on average, there were still substantial losses in earnings in this group.

Economic losses were roughly evenly split between three categories:

• direct costs to the NHS of treating smoking-related health problems,
• loss of earnings due to days off sick from work, and
• loss of earnings due to premature death before retirement age.

It’s well established that smoking rates are much higher in people with mental health problems; this study claims they are approximately 50 per cent higher. And although smoking rates are going down in the general population, excessive smoking in people with mental health problems remains an issue.

On top of this, according to the Royal College of Physicians, people with mental health problems have lower life expectancy than the general population, and a lot of this reduced life expectancy is related to diseases caused by smoking.

But historically, there has been some suggestion that trying to help people with mental health problems to quit smoking was not practical, and might even be detrimental to their mental health. A lot of patients reported smoking as self-medication, and there was an attitude among some that these people ‘had enough on their plates’, without taking away their comforting cigarettes, particularly if there may be some perceived benefit of nicotine to various psychiatric disorders.

Cigarettes were even used as bartering tools by health professionals as a way of engaging with patients.

Of course, helping someone improve their mental health condition is hugely important, but when the leading causes of death among people with schizophrenia are lung cancers, cardio-vascular diseases, pulmonary diseases, and other smoking-related illnesses, the ethicality of such behavior on the part of health professionals becomes more questionable. Not only that, but a recent study found that patients with mental health problems who reduced their smoking, or quit, showed improved outcomes in their mental health.

When patients with mental health problems are asked about their smoking, they are as keen to quit as smokers in the general population. However, at the moment there’s been very little research in to the effectiveness of various types of smoking cessation techniques in populations with mental health problems, and at present people with mental health problems find it harder to stop smoking and are less likely to succeed.

While there is some evidence that nicotine (rather than cigarettes) might ease some symptoms of schizophrenia, evidence is far from conclusive, and in any case, there are other, much less harmful methods of nicotine administration than cigarettes.

There is also growing evidence that higher rates of smoking actually precede the onset of mental illness in both schizophrenia, depression, and recently Alzheimer’s and dementia, suggesting that smoking could even be a risk factor for these disorders – although there’s not yet strong evidence that this is the case.

Whatever the role of smoking in mental health, if these people are disproportionately suffering from smoking related illness, losing earnings, and dying early, then it is the duty of healthcare professionals to help them quit if they want to, and to find effective means to do so.

Suzi

• A version of this post has also been published on Suzi’s Sifting the Evidence blog.

Reference

• Wu Q., J. Britton & S. Parrott (2014). Economic cost of smoking in people with mental disorders in the UK, Tobacco Control, DOI: http://dx.doi.org/10.1136/tobaccocontrol-2013-051464

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