Patients in mental health wards need better quit support as government prepares to ban smoking on hospital grounds

New research [1] from Action on Smoking and Health (ASH), funded by Cancer Research UK, finds that people admitted to mental health trusts have better access to treatment for smoking than they did 5 years ago but are being let down by a failure to create smokefree care environments. The findings come as the government prepares to ban smoking on all hospital grounds.

Smoking rates among people with Serious Mental Illness (SMI) are estimated to be around 40%, with even higher rates among inpatients. The research found that 70% of mental health trusts now offer quit support to patients who smoke. These services have been funded to deliver on the 2019 NHS Long Term Plan commitment to implement stop smoking support in mental health settings, mainstream hospital care, and maternity services. However, funding for mental health settings has been less than anticipated and only 42% of trusts report that they are able to offer support to all patients who smoke.

Smoking indoors is banned under 2007 smokefree legislation and NICE recommends that all hospital sites should be smokefree, something the government intends to put into law following the passage of the Tobacco and Vapes Bill.

There were few changes in smokefree policies between 2019 and 2024 (when the survey was conducted) with 85% of trusts reporting they had a policy. However, within those 15% reported that smoking was still permitted on site, something likely to be prohibited under new regulations.

Breaches to smokefree policies were also common. While smoking inside has declined since the last survey, smoking on hospital grounds remains commonplace with half of trusts reporting some smoking on grounds every day and half reporting that staff escorted patients to smoke daily, contradicting NICE guidance.

Access to vaping products was seen as an important way to support smokefree policies and help patients stay smokefree. However, trust policies on access to vapes and where they can be used varied considerably.

Organisational culture and lack of funding were identified as critical barriers to progress in supporting more people to be smokefree.

The report recommends:

• Secure funding for tobacco dependence treatment services in mental health trusts.
• Action from NHSE and DHSC to ensure that healthcare settings are prepared for any changes in the law.
• Better access to the stop smoking medications varenicline and cytisine, which are under-prescribed to people with mental health conditions, alongside consistent access to vapes and NRT.
• Mandatory training for all staff working in mental health trusts to address widely-held misconceptions about the impact of smoking on mental health.

Ex-smoker Hannah, who has been admitted to mental health inpatient wards and was involved in this survey, said:

“I have struggled to quit smoking most of my life and very rarely has being an inpatient on a mental health ward done anything other than increase the amount I smoke. I do not want to die young and I do not want to spend my money on smoking. I do want the people involved in caring for my mental health to care about my physical health. Mental health wards are changing, but not fast enough.”

"There is already around a 20 year mortality gap between the general population and people with an SMI and smoking has a massive part in this. I don’t want to be part of this gap and it worries me that if things don’t change for the better in inpatient mental health units soon that this gap will only get bigger, and people I know and love, who I’ve spent many years in the system with, will continue to smoke and WILL be part of this mortality gap!"

Norman Lamb, Chair of South London and Maudsley NHS Foundation Trust and former Chair of the Science and Technology Select Committee, said:

“This report makes sober reading. We have made progress, but we need to do more to address smoking across our mental health hospitals. I am particularly frustrated that despite recommendations I made as Chair of the Science and Technology Select Committee in 2018 that the NHS should have consistent guidance on access to vapes, which can save smokers’ lives, there are still inconsistent policies across the country. At the least we should be able to provide consistent access to the treatments that will best help people to stop smoking.”

Prof Ann McNeill, Co-chair of the Mental Health and Smoking Partnership and Professor of Addictions at King’s College London, said:

“In 2025 with smoking rates still unbelievably high for people with mental health conditions it can no longer be acceptable that we do not provide supportive smokefree care as part of our wider strategy to reduce the inequalities that smoking causes. The scale of ambition for change with this population must be as great as the damage smoking causes.”

Dr Ed Beveridge, Presidential Lead for Physical Health at the Royal College of Psychiatrists, said:

“We have made a good start at better supporting our patients to address smoking, but this is a marathon rather than a sprint. The rate of smoking in our hospitals remains too high. When we fail to address our patients’ smoking this contributes to illness and lost years of life in the longer term. There are also immediate implications for their mental health, the doses of some of the medicines they need and the money in their pockets. As mental health professionals, we need to work quickly and with determination to make sure our patients are not left behind as the country moves ever closer to being smokefree.”

Malcolm Clark, Senior Policy Prevention Manager at Cancer Research UK, said:

“Around 6 million people smoke in the UK, and research shows that some groups are more likely to than others, including people with mental health conditions.

“Stopping smoking completely is the best thing you can do for your health, and this report shows encouraging progress in helping patients at mental health trusts to quit. Nobody should be left behind in the journey to a smokefree UK, and that’s why sufficient and sustainable funding is vital for services that will help people quit smoking for good.”

ENDS

Notes to the Editor

Action on Smoking and Health (ASH) is a health charity working to eliminate the harm caused by tobacco use. For more information, visit ash.org.uk. ASH receives funding for its program of work from Cancer Research UK and the British Heart Foundation.

For interviews or more information, contact press@ash.org.uk

References

[1] ASH & Cancer Research UK. Space to breathe: Findings from a survey of smokefree policies and tobacco dependence treatment services in NHS mental health trusts in England, 2024. March 2025