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Smoking and mental health

This joint report by the Royal College of Physicians and the Royal College of Psychiatrists draws on substantial evidence to highlight the plight of smokers with mental disorders, and reveals that only a minority of people from this group receive effective smoking cessation interventions by the NHS. This causes major reductions in their life expectancy and quality of life, exacerbates poverty and presents huge economic costs to the NHS and wider society.

Key recommendations

  • Smoking is extremely common in people with mental disorders, causing major reductions in life expectancy and quality of life, exacerbating poverty and presenting major economic costs to the NHS and wider society.
  • Despite consuming a large proportion of tobacco in the UK and being heavier smokers, only a minority of people with mental disorders receive effective smoking cessation interventions.
  • Prevention and treatment strategies to date have made little if any impact on smoking in this population.
  • This failure does not arise from substantially lower motivation among smokers with mental disorders to quit smoking.
  • It is likely that the persistent acceptance of smoking as a normal behaviour in primary and secondary care, and failure by health professionals to address smoking prevention as a health priority, drives and perpetuates the high prevalence of smoking in people with mental disorders.
  • This persistent high prevalence of smoking reflects a major failure of public health and clinical services to address the needs of a highly disadvantaged sector of society.
  • There is a moral duty to address this problem in the future, and to prioritise the rights of people with mental disorders to the same protection and health interventions as the general population
  • Smoke-free policy is crucial to promoting smoking cessation in mental health settings.
  • All healthcare settings used by people with mental disorders should therefore be completely smoke free.
  • Smokers with mental disorders using primary and secondary care services, at all levels, should be identified and provided routinely and immediately with specialist smoking cessation behavioural support, and pharmacotherapy to relieve nicotine withdrawal, promote cessation and reduce harm.
  • Commissioners should require mental health service settings to be smoke free, and to provide support for cessation, temporary abstinence and harm reduction.
  • Service indicators, such as the primary care Quality Outcome Framework (QOF) and Commissioning for Quality and Innovation (CQUIN), should measure and incentivise cessation, not just delivery of advice to quit.
  • All professionals working with or caring for people with mental disorders should be trained in awareness of smoking as an issue, to deliver brief cessation advice, to provide or arrange further support for those who want help to quit and to provide positive (ie non-smoking) role models. Such training should be mandatory.
  • There is no justification for healthcare staff to facilitate smoking.
  • Research funding agencies should consider encouraging and investing in research to address this major cause of ill-health, and health inequalities, in British society.