Smoking and mental health: a framework for action in Wales
06 June, 2024
Welcome to this month’s blog post, in which Dr Joseph Lloyd Davies, Lecturer in Applied Psychology at the Cardiff Metropolitan University, introduces our new report Smoking and mental health: A framework for action in Wales and the four recommendations on how to better support people with mental health conditions to quit smoking.
In Wales, as in the rest of the UK, there is a concerning trend of smoking among people with mental health conditions. Fourteen percent of people in Wales smoke cigarettes1, but the figure is more than twice that for people with a mental health condition. Data from Wales show that smoking prevalence for people with a mental health conditions is 33%.
This is particularly troubling given that smoking is a leading contributor to the lower life expectancy for people with mental health conditions compared with the general population2.
What can be done to break this harmful cycle? And why is smoking so prevalent among those with mental health conditions?
Recommendations for a smoke-free Wales
Our report, Smoking and mental health: A framework for action in Wales, makes recommendations for actions to reduce smoking and improve mental health for people with mental health conditions in Wales. The recommendations are:
- To improve smoking cessation support in mental health settings, and provide staff training that addresses misperceptions of the relationship between smoking, quitting and mental health conditions
- To update smoking cessation interventions and programmes to better support people with mental health conditions, driven by co-production with service users
- To improve access to nicotine replacement therapy and other smoking cessation medications, offering multiple options for increased success
- To address data gaps by collecting and reporting smoking rates, particularly among those with mental health conditions.
The link between smoking and mental health
Smoking is often intertwined with mental health struggles, because it becomes a coping strategy3,4. Smoking can negatively impact mental health, which could make symptoms of mental illness feel even worse5, leading to a vicious cycle.
Research consistently shows that quitting smoking can support recovery from mental health conditions6. The Welsh Government aims for a smoke-free Wales by 2030, guided by the Tobacco Control Delivery Plan 2022–2024. However, gaps in implementation hinder adequate support for those with mental health conditions7. The Help Me Quit services offers various cessation aids, but it wasn't designed to address the challenges faced by individuals with mental health conditions.
Current strategies and their shortcomings
Current interventions to reduce smoking include the Help Me Quit services, which offer a single point of access for smokers in Wales to get support for smoking cessation. Service users can access face-to-face support, telephone support, pharmacotherapy (for example, nicotine patches) and self-help resources. This range of services is useful for supporting smoking cessation in the general population, but as the services were not designed alongside people with mental health conditions they do not meet their specific needs.
Tailored interventions: A promising approach
Specialised smoking cessation programs are in development and being evaluated, and so are not widely available for people with mental health conditions in Wales. In the smoking cessation intervention for severe mental illness (SCIMTAR+) trial, participants diagnosed with bipolar disorder and schizophrenia were randomly assigned to receive standard care or a smoking cessation programme specifically for people with these serious mental illnesses.
The authors found a significant difference in smoking cessation rates at 6-month follow-up, with people who received the tailored intervention being more likely to quit. However, this effect did not continue after 12 months, which suggests that while bespoke smoking cessation interventions are promising, additional support may be required beyond the initial 6 months.
Together, by considering the context and strategies, and following the four recommendations, we can create a smoke-free future for everyone in Wales.
Acknowledgements
References
- Office for National Statistics. (2022). Adult smoking habits in the UK: 2022.
- Das-Munshi J, Chang CK, Dregan A, Hatch SL, Morgan C, Thornicroft G, et al. (2021). How do ethnicity and deprivation impact on life expectancy at birth in people with serious mental illness? Observational study in the UK. Psychological Medicine, 51(15), 2581–2589.
- Wootton R, Sallis H, Munafò M. (2022). Is there a causal effect of smoking on mental health? A summary of the evidence. University of Bristol, on behalf of Action on Smoking and Health.
- Bellis M, Ashton K, Hughes KE, Ford K, Bishop J, Paranjothy S. (2016). Welsh Adverse Childhood Experiences (ACE) Study; Adverse Childhood Experiences and their impact on health-harming behaviours in the Welsh adult population (ISBN 978-1-910768-23-5). Public Health Wales NHS Trust.
- Taylor GM & Treur J. (2023). An application of the stress-diathesis model: A review about the association between smoking tobacco, smoking cessation, and mental health. International Journal of Clinical and Health Psychology, 23.
- Taylor GM, Lindson N, Farley A, Leinberger-Jabari A, Sawyer K, te Water Naudé R, et al. (2021). Smoking cessation for improving mental health. Cochrane Database Systematic Reviews, 3.
- National Collaborative Commissioning Unit & Royal College of Psychiatrists Wales. (2024). Enabling environments spotlight report: Adult community mental health teams.