1.5 million people with poor mental health smoke – how can we stop them being left behind?

Dr Ed Beveridge, co-chair of the Mental Health and Smoking Partnership and Presidential Lead for Physical Health at the Royal College of Psychiatrists

As mental health professionals, we spend a great deal of time thinking about how we can improve people’s mental and physical wellbeing. But too often, the biggest contributor to poor physical health and premature mortality among people with mental health conditions – smoking – is overlooked.

Today, the Mental Health and Smoking Partnership and ASH are publishing a new report, Falling through the cracks: Closing the gap in stop smoking support for people with common mental health conditions, highlighting the urgent need for stronger action to reduce smoking-related inequalities among people with common mental health conditions like depression and anxiety. 

There are 1.5 million people in England with depression and anxiety who smoke, accounting for almost a third of all smokers. Despite this, there is no national target for reducing smoking in this population and the NHS hasn’t published data on smoking among people with depression and anxiety since 2017.

These are not just statistics. Behind them are people living with overlapping challenges; poor physical health, financial pressures and wider social disadvantage. Smoking rarely exists in isolation. It often compounds the inequalities people already experience.

For many years, smoking has been viewed in mental healthcare as something separate and secondary to treatment, or even wrongly viewed as a coping mechanism. We now know this thinking is outdated.

The evidence is clear: smoking can worsen mental health and wellbeing, while quitting can improve anxiety, depression and quality of life.

Importantly, people with mental health conditions are just as motivated to quit smoking as anyone else. The problem is not motivation. Too often, it is access to support that is flexible, tailored and designed around their needs.

There are some promising examples of progress. Across the country, local authorities, NHS services and community organisations are developing innovative ways to support people with poor mental health to quit smoking. This involves integrating smoking cessation into existing pathways, building partnerships and reaching people through trusted community settings. This demonstrates what is possible.

But too often good practice remains dependent on local leadership and individual champions. What is missing is clear guidance and direction from the Government to build on the progress that has been made locally. This means a new tobacco strategy that puts people with mental health conditions front and centre; measurable targets; robust data collection; investment in quit support embedded within routine care; clear accountability; and training to equip professionals with the confidence and skills to act.

Smoking among people with poor mental health is not inevitable – it is preventable. We know what works. We have examples to build on. The challenge is delivering support at scale to ensure that everyone, regardless of their mental health, gets the help they need to quit smoking for good.