smoking and mental health

Smoking rates are higher among people suffering from mental health disorders. It has been proposed that smoking has an impact on people’s mental health, and that stopping smoking could help to improve mental health. There are a number of ongoing research studies investigating if this is the case.

Position statement

We are calling for all mental health care institutions in Wales to adopt a smokefree policy since we believe this would promote a healthier and more positive attitude amongst staff and patients.

Currently in Wales, mental health units which provide residential accommodation for patients are exempt from the Smoke-free Premises Regulation Act 2007. Mental health units which provide residential accommodation for patients in England, however, are required to enforce smoke free policies, and according to a 2015 YouGov survey commissioned by us 61% of the Welsh public support a similar law in Wales.


1 in 4 British adults experience at least one mental health problem in the course of a year1 with mixed anxiety and depression the most common mental disorder. Estimates vary, but research suggests that 20% of children have a mental health problem in any given year, and about 10% at any one time2.

Gender General Population % Those with mental health %
Men 20 36
Women 17 31
All 19 33

Smoking prevalence and mental health

Considerably higher smoking rates are observed amongst people with a mental health disorder relative to the general population. Research has shown individuals with a mental illness are about twice as likely to smoke as other persons3. According to the 2015 Welsh Health Survey, in which respondents with a mental illness are defined as those who report they are currently being treated for depression, anxiety or ‘another mental illness’, the smoking prevalence among mentally ill adults is 33%. This compares with a smoking level of 19% reported among the whole of the adult population in Wales. In keeping with the pattern observed within the general population, males with a mental illness have a higher smoking prevalence rate than females (36% vs 31%), however the gender difference is more marked among those with a mental illness.

Evidence also suggests that together with a higher prevalence of smoking among people with a mental illness such individuals additionally smoke a higher number of cigarettes4.

It is very difficult to establish a causal relationship between smoking and mental health because many people begin smoking before they are diagnosed with a mental health illness. It has so far not been possible to determine whether smoking increases the risk of developing a mental disorder or having a mental disorder increases the risk of smoking. People with mental health disorders may view smoking as a coping mechanism for some of the side effects of their mental illness.

Promoting smoking cessation has historically not been seen as a priority by mental health workers, despite the potential consequences of smoking for a patient’s physical health. A ‘smoking culture’ therefore developed around many mental health settings, with smoking not being challenged by staff for a wide variety of reasons. Nevertheless, we know that smokers with mental disorders are just as likely to want to quit as those without. Effective smoking cessation programmes for people who have mental health issues are designed around their specific mental illness; they involve flexible programmes that accommodate their lifestyle.

Smoking cessation and mental health

Health professionals in Wales are calling for immediate action to better support those with mental ill health to quit smoking as figures show rates are 14% higher than in the general population.

The Wales Tobacco or Health Network (WTHN), run by tobacco control campaign group ASH Wales, say a full and robust response is needed including; a national bespoke cessation service, training for health workers and a ban on smoking in mental health residential units.

Currently 33% of those with a mental health illness smoke compared to just 19% of the general population across Wales.

Current Legislation

Plan Proposed for summer 2019 – Placing an 18-month time limit on the permission to designate a room for smoking within mental health units. The time limit would allow managers to work towards the removal of indoor smoking facilities and designate outdoor areas instead. Current Legislation allows smoking outside mental health hospital although some have voluntary bans.

Further Reading

1The Office for National Statistics Psychiatric Morbidity report (download). 2001

2Lifetime Impacts: Childhood and Adolescent Mental Health, Understanding the Lifetime Impacts, Mental Health Foundation. 2005

3Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness: a population-based prevalence study. JAMA. 2000;284(20):2606-2610

4Lawrence D, Mitrou F Zubrick SR. Smoking and mental illness: results from population surveys in Australia and the United States. BMC Public Health 2009; 9:285

Further Research

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