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.