smokingNearly two thirds of people using mental health services are addicted to tobacco but inpatient mental health units lack the necessary stop-smoking services to support them, a new Public Health England (PHE) report has claimed.

Nationally, 33% of people with a mental health problem smoke, rising to just under two-thirds in mental health units, compared to 18.7% in the population as a whole, according to the PHE and NHS England survey.

The authors suggest that high smoking rates among people with mental health problems are the single largest contributor to their 10 to 20-year reduced life expectancy.

Professor Kevin Fenton, national director of health and wellbeing at PHE, said: "Public Health England’s vision is to reduce the unacceptable inequalities in health experienced by people living with mental health problems – starkly illustrated by our figures showing smoking rates in mental health units three times those in the population as a whole.

"We cannot allow this, or the myth that smoking improves mental health, to continue. Our role is to speak to the evidence and this guidance highlights best practice for commissioners to reduce smoking in mental health units – as we move towards delivering care in an environment free of smoke - as we are in other NHS hospitals across the country."

The guidance also highlights case studies which show the benefits of completely smoke-free mental health units, where service users are provided support to stop smoking. This has resulted in:
• Better patient health
• Freeing up staff time
• Improved ward atmosphere.
Alongside the physical health improvements, an increasing body of research is finding that mental health can be improved by stopping smoking. Contrary to the myth, evidence shows that stopping smoking is associated with reduced depression, anxiety, stress and improved positive mood and quality of life.

Disproportionate number of premature deaths
Evidence also shows that people who smoke often require higher doses of psychotropic medication as smoking increases the metabolism of these drugs. Smoking is estimated to increase psychotropic drug costs in the UK by up to £40 million per year. Medical guidelines indicate stopping smoking can lead to reductions in dosage and usage of psychotropic drugs which benefits the patient by reducing the side-effects associated with these medications.

In response to the findings, Brian Dow of Rethink Mental Illness said: "People with severe mental illness are at risk of dying 20 years younger than average because of preventable physical health conditions, and smoking plays a massive part in that.

"The problem is that while people with mental illness are much more likely than average to smoke, they are rarely given any encouragement or support to give up. Mental health professionals can be reluctant to address the issue, because they sometimes see smoking as the one of the last pleasures available to people in inpatient care.

"That attitude, while often well-intentioned, is misplaced because it contributes to a disproportionate number of premature deaths amongst people with severe mental ill health. We need to see specialist stop-smoking services put in place in both community and inpatient mental health services across the country, otherwise people with mental illness will continue to die needlessly from preventable physical health problems."