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According to “Smoking and Health”, the latest report published by the Royal College of Physicians and the Royal College of Psychiatrists, smoking in mental health patients is being neglected by the UK National Health Service, which results in a deterioration of the patients’ quality of life and in a substantial increase of healthcare costs.

The joint report produced by the Royal College of Physicians, an EPHA member, and the Royal College of Psychiatrists on Smoking and Mental Health, released in March 2013, reveals a devastating fact: although the smoking prevalence in the UK’s general population has experienced a marked decline over the past 20 years, falling down to around 20%, it has barely changed among people with mental health conditions – the figure reaching 40% of smokers in this group. In the UK, one in three of the 10 million smokers suffers from a mental health condition, of which 1 million have a longstanding condition. This is likely to be one of the main causes of decreased life expectancy, estimated to be at around 10 years.

According to the report findings, people with depression, eating or behavioural disorders and anxiety have a higher dependence on smoking and are twice as sensitive to become smokers, although the mechanisms underlying this connection are not clear.

People with mental health conditions are as likely to want to quit smoking as the general population. However, as they tend to be more addicted to nicotine, they need a more intensive support. Unfortunately, over the course of a year, only half of them are advised to quit by their doctor and just one in ten are prescribed smoking cessation medicines. People treated in specialist mental health settings are in an even more disadvantaged situation. Although all NHS mental health trusts in England are now smoke-free, smoking is part of the culture of many of these settings, where it is seen as a normal behaviour often facilitated by the staff. This makes smoking cessation even more difficult.

The cost of treating smoking-related diseases in people with mental health conditions reaches £720 million yearly (about 850 million euros), arising mostly from people diagnosed with anxiety and/or depression. So, reducing the percentage of smokers among this group is an urgent national priority that would lead to substantial improvements in people’s quality of life and life expectancy, as well as to cost savings to the NHS. The UK Department of Health has already committed to tackling this issue in the future, focusing efforts on reducing smoking among vulnerable groups.

Key recommendations of the report :

  • Mental health settings need to be smoke-free and to provide support for cessation, temporary abstinence and harm reduction.
  • Professionals working with people with mental disorders should be trained on smoking awareness, brief cessation advices and further support to those who want to quit. Generally, they should act as positive role models.
  • Smokers with mental health conditions should be identified by primary and secondary care service users and provided with specialist smoking cessation support and pharmacotherapy to relieve nicotine withdrawal.
  • Service indicators should measure and incentivise cessation, not just deliver advice to quit.
  • Research agencies should increase their efforts and further encourage and invest in research addressing this cause of ill-health.

– Report on “Smoking and Mental Health

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