ASH Scotland urges Scottish Government to increase smoking cessation support for 230,000 Scots with mental health problems

ASH Scotland is urging the Scottish Government to do more to tackle health inequalities by increasing specialist smoking cessation service support for the estimated 230,000 people in Scotland who smoke and are experiencing mental health problems.

The call comes as the health charity publishes its Closing the Inequality Gap: Smoking and Mental Health report which reveals current smoking prevalence for people experiencing mental health problems in Scotland’s poorest communities is between 40 to 50 per cent, comparable to the country’s general population smoking rates back in the mid-1970s. In contrast, the present smoking rate for people without mental health problems in Scotland’s wealthiest areas is only four per cent.  

With the Scottish Government refreshing its strategies to improve mental health and address tobacco control in the upcoming months, ASH Scotland says it is vitally important that both strategies prioritise improving the physical health of people with mental health problems by making connected commitments to support cessation and smoking prevention work among this priority group. 

The charity wants the government to set a specific key performance indicator and regularly report to show progress of reducing smoking prevalence among people with mental health problems and the narrowing of the inequality gap with the general population smoking rate, which currently stands at 17 per cent. 

Sheila Duffy, Chief Executive of the health charity ASH Scotland, said: “With almost half of people with a mental health problem in our most deprived communities smoking, our new report is spotlighting a serious health inequalities gap, which needs to be urgently addressed.

“People with mental health or substance misuse issues smoke more, tend to be more addicted to nicotine, and find it harder to quit than others in society. It is vital that people in this group are supported and empowered to make informed decisions about quitting smoking to improve their health and wellbeing.

“There is a common misconception that smoking is a relaxant, when such feelings are only temporary and soon give way to increased cravings and withdrawal symptoms like anxiety, depression and fatigue. Nicotine dependence is the main stress that is relieved so smoking can actually worsen the mental health of people who are already struggling.   

“Despite people with mental health issues smoking disproportionately more, they are just as likely to want to quit as the rest of the population – and the benefits of quitting can be considerable in providing relief from their symptoms as well as better physical health.

“Going forward, the Scottish Government must ensure that NHS boards are required and resourced to provide specialist person-centred smoking cessation advice to people with mental health problems, and performances are measured to demonstrate successes by those important services are being achieved.”

In its report, the charity highlights the good practice of NHS Lanarkshire whose Tobacco Control Strategy (2018-23) lists people with mental health problems as a priority group and there is a focus on reducing smoking in the most deprived communities. Specialist support is offered to anyone experiencing mental health issues who is ready to quit smoking, with dedicated advisers providing support and advice on nicotine replacement products. For people experiencing more severe mental health problems, a mental health nurse specialist works to support smoking cessation in both community and acute settings.  

Sharon Rankine (NHS Lanarkshire) with Liam Walker, who was supported to quit smoking.

Sharon Rankine, mental health nurse specialist, NHS Lanarkshire, said: “Stopping smoking is associated with improved mental health and overall wellbeing. Many people with a mental health diagnosis have successfully quit smoking with the help of our specialist service.

“It is often believed that the withdrawal from nicotine has a negative impact on mental health, however, the results are the opposite. Those who have successfully quit, regularly report improved self-esteem and confidence.

“People living with mental health conditions are just as motivated to quit as the rest of the population who smoke and stopping can lead to an improvement in mental health for those with depression, anxiety and stress as well as an overall better quality of life. Quitting smoking is achievable, and our specialist support is available when you’re ready.”

Liam Walker, 47 from Airdrie, who successfully quit smoking after using NHS Lanarkshire’s specialist service, said: “I had help from the Quit Your Way mental health nurses to support me to stop smoking. They gave me help and information which I found really clear, given I have some learning disabilities. I was provided nicotine gum, which was a great support. I have now stopped smoking and I am doing really well.

“My mental health was really bad. It was hard not to think of smoking when I first stopped but the nicotine gum helped with my cravings and my mental health has really improved since I quit. I feel much healthier and I’m saving so much money too.”

ASH Scotland’s Closing the Inequality Gap: Smoking and Mental Health report can be downloaded from www.ashscotland.org.uk/mentalhealth