Ciaran Osborne, Director of Policy and Pretty Rahman, Communications Manager at Action on Smoking and Health (ASH)
Many of us struggle to manage our physical and mental health at the same time. For people with serious mental health conditions, particularly those who need inpatient treatment, this can be especially complex.
Sometimes tackling smoking and an acute mental health crisis at the same time can seem like too much to take on. But there’s no evidence to suggest it can’t be done. As all NHS trusts are (or should be!) smokefree, so inpatient care can actually be a really good place to help people to quit smoking.
The benefits of quitting are enormous – not just for physical health but for mental health too. A systematic review of studies measuring changes in mental health following smoking cessation found that quitting smoking was associated with reduced depression, anxiety and stress, and improved positive mood and quality of life, compared with continuing to smoke.
That’s why it is crucial that NHS mental health trusts do all they can to help their patients to quit, both as inpatients and in the community.
At Action on Smoking and Health (ASH), we worked with Public Health England to publish a new report looking at the implementation of smokefree policies in NHS mental health trusts.
Smoking rates among people with serious mental health conditions are much higher (34.1%) than in the general population (14.4%).
We found that 4 in 5 (82%) mental health trusts have a comprehensive smokefree policy in place, making reasonable progress towards the Government’s 100% target for 2019. But is this progress good enough?
Progress on this topic is important because smoking rates among people with serious mental health conditions are much higher (34.1%) than in the general population (14.4%). Smoking is also the largest single contributor to the average 10-20 year reduction in life expectancy among people with mental health conditions.
However, we found that not all inpatients with mental health conditions are getting the support they need to quit smoking. NICE guidance makes clear recommendations on mental health trusts about helping people with mental health conditions to stop smoking. But some trusts haven’t taken all the steps needed to put these recommendations into practice.
What needs to be done?
We found that almost 1 in 5 trusts still do not have a comprehensive smokefree policy in place, even though the Government deadline for implementation was last year.
These trusts should make adopting comprehensive smokefree policies a priority. They can seek guidance from Public Health England, NHS England and other trusts where such policies are in place and working well.
We also found that though all trusts offer Nicotine Replacement Therapy (NRT) to their patients, only 47% offered the most effective smoking treatment of either combination NRT, or varenicline. All trusts should offer both treatment options, with behavioural support, to give people the best possible chance of quitting and improving their mental and physical health.
In 55% of surveyed trusts, patients were not always asked their smoking status on admission. This goes against NICE recommendations. All trusts should make sure smoking status is consistently recorded on patients’ admission to acute mental health services. Tobacco smoke interacts with some psychiatric medication making it less effective, and so smokers may need increased dosages and experience more side effects when using these drugs. Equally, smokers on these medications who reduce their tobacco consumption may need to be prescribed lower doses.
We also found that though all trusts offer Nicotine Replacement Therapy (NRT) to their patients, only 47% offered the most effective smoking treatment of either combination NRT, or varenicline.
Disappointingly, the report found that staff accompanied patients on smoking breaks every day in more than half (57%) of surveyed trusts. This is despite NICE recommending no staff-supervised or staff-facilitated smoking breaks for people using secondary care services. Mental health trust managers and smokefree leads should work with ward managers and staff to eliminate the time spent escorting patients on smoking breaks, as this normalises and condones smoking.
Smoking prevalence among people with mental health conditions began to fall for the first time in the Annual Psychiatric Morbidity Survey 2014. But we will all need to work hard to ensure the right support is provided. With the simple steps above, mental health trusts can make a substantial contribution to that goal.