smoking and mental health

In Wales 36% of adults with a mental health condition smoke, compared to 17% of the whole adult population in Wales.  Across the UK people who are mentally ill smoke more than a third of all the tobacco smoked in the UK, and smoking is the biggest contributor to those with mental ill health dying 10 to 20 years earlier than the general population.

Evidence shows that smoking does not support good mental health, and stopping smoking is associated with improvements in conditions such as depression, stress and anxiety.

How nicotine affects the brain

Many smokers use cigarettes to relieve stress, and do not know the damage their habit could be doing to their mental health and wellbeing. The common misbelief that smoking aids relaxation often prevents smokers from successfully quitting.

When people say that smoking calms them down this is a result of the nicotine that is released to the brain when smoking which causes the release of dopamine, a chemical reaction that leads to feelings of calmness and reward. This rewarding feeling only lasts for a small period of time however as dopamine levels quickly reduce, leading to withdrawal symptoms which can make symptoms of anxiety, stress and depression worse.

0 % at least
of all tobacco consumed in the UK is used by people with mental health issues
0 % and over
of people who have a diagnosis of schizophrenia smoke tobacco
just under 0 %
of those who experience a first episode of psychosis are smokers

Smoking prevalence and mental health

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. 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 cigarettes 4.

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 smoking  %
Men 20 41
Women 17 34
All 17 36

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, incorporating smoking cessation support and nicotine replacement therapy, 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.

ASH Scotland - Mental health, nicotine replacement therapy and smoking cessation services

ASH Scotland - How smoking causes stress

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