A recent debate in the House of Commons about the state of mental health in the UK (which will hopefully become an annual debate) highlighted the links between mental health and physical health, and in particular smoking and major mental illnesses like schizophrenia. Charles Walker MP expressed concern that the there was too much focus on managing the mental health symptoms at the expense of physical health issues. He said: “It does not matter if they are smoking 70 or 80 cigarettes a day, because they are not making a nuisance of themselves. It does not matter if they weigh 20 to 25 stone, because they are not making a nuisance of themselves. It does matter, however, because that patient is slowly killing himself or herself and we have to address that.” Harsh words but is there evidence to back it up, and if so what can we do about it?
A recent report by the Royal College of Psychiatrists (RCP) (2013) revealed that smoking is around twice as common among people with mental disorders, and even more so amongst people with the severest mental disorder, and that one in three of all cigarettes smoked in England are smoked by people with a mental disorder. The report also found that, whilst smoking rates generally have declined in recent 20 years, they have hardly done so amongst people with mental disorder.
We sometimes hear people say things like “smoking is one of the few pleasures he has, don’t take that away from him” and I agree we don’t want to take choices away from people who may already have had many life choices reduced by the disabling effects of mental illness. On the other hand, people have got the right to make informed choices, including opting for a healthier lifestyle where possible, and the RCP report conclusions make that point. The report recommends that staff working with people with mental disorder should be aware of support available to help people stop smoking.
I am sure there is a role for care staff in this important area of health promotion. Whilst care homes may allow residents to smoke in designated areas, residents are entitled to support if they wish to stop. A person with schizophrenia will, on average, live for 10 years less than someone without a mental health problem and smoking is surely a factor in that (Mental Health Foundation 2007 p.43). Service users should be encouraged and supported to get a physical health check from their GP. Let’s give service users the choice of healthier living!
Royal College of Physicians, Royal College of Psychiatrists. Smoking and mental health. London: RCP, 2013
Mental Health Foundation The Fundamental Facts The latest facts and figures
on mental health MHF, 2007