smoking and mental health

Health professionals in Wales are calling for immediate action to better support those with mental health problems to quit smoking as figures show rates are 17% higher than in the general population (2017-18 National Survey for Wales).

Members of the Wales Tobacco or Health Network (WTHN), run by 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.

Smoking prevalence and mental health

Considerably higher smoking rates are observed amongst people with a mental health problem relative to the general population. Research has shown individuals with a mental illness are about twice as likely to smoke as others who do not suffer from mental health issues 3.

According to the 2017-18 National Survey for Wales, respondents with a mental illness are defined as those who report that they have a long-standing mental health condition. The smoking prevalence within this group was 36% compared to the 19% reported among the whole of the adult population in Wales in 2017-18. In keeping with the pattern observed within the general population, males with a mental illness have a higher smoking prevalence rate than females (41% vs 34%), 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.

Wales Statistics

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

Smoking legislation in mental health units in Wales

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.

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

Proposed legislation

Legislation has been proposed for summer 2019 which would introduce 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 hospitals 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