Our key policy asks & recommendations

This page provides a brief overview of the Mental Health and Smoking Partnership's key recommendations to reduce smoking for people with a mental health condition.

1. Pass legislation to raise the age of sale for tobacco by one year, every year, to create a smokefree generation. Preventing future generations from becoming addicted to smoking will significantly benefit their physical and mental health.
2. Publish a roadmap to a smokefree country including a comprehensive strategy to eliminate the disparity in smoking rates between people with and without mental health conditions.
3. Fully implement commitments made in the NHS Long Term Plan to provide smoking cessation support to people with long term mental health conditions in inpatient and community settings.
4. Ensure vaping products remain accessible to adults with mental health conditions for smoking cessation, including in inpatient care settings. NHSE and OHID should issue joint evidence-based guidelines to support decision making on vaping in NHS trusts and local stop smoking services.
5. Identify opportunities to address smoking among people with common mental health conditions such as anxiety and depression.
6. Challenge the myth that smoking reduces stress and anxiety through national comms activity and information in cigarette packs.

Smoking is undermining government goals to improve physical health of people with mental health conditions:

• High smoking rates among people with mental health condition are a leading cause of premature death and disease. Smoking accounts for two-thirds of the reduced life expectancy of people with a serious mental illness (SMI).
• Smoking rates are high in most groups with poor mental health. The highest rates of smoking are among people with substance use issues e.g. 70% of those receiving treatment for opiates smoke. People with Serious Mental Illness (SMI) have more than three times the smoking rate of the general population (41% verses 14%). The rate among people with depression and anxiety is just under twice that of the general population (26% verses 14%) but they account for around 1.6 million smokers.

Increasing quitting can improve population level mental health, reduce burden on the NHS and improve the wealth and employment prospects of people with mental health conditions:

• Stopping smoking improves mental health: There is now good evidence that stopping smoking improves mental health and wellbeing. The effect is comparable to the impact of anti-depressants.
• Smoking exacerbates levels of poor mental health: Smoking contributes to development of some mental health conditions (including schizophrenia and depression) and damages people’s wealth, health and employability, further contributing to the burden of poor mental health.

Without targeted action people with mental health conditions will be left behind:

• Smokefree generation: While the Tobacco and Vapes Bill is needed to protect future generations, it will do very little for the 6 million people who already smoke, a disproportionate number of whom live with a mental health condition. This group have the same desire to quit as the general population but face greater barriers to doing so. Without a step change in the support offered to smokers with mental health conditions, there is a real risk they will be left further behind as we move towards a smokefree future, exacerbating health inequalities.
• For more information see the written evidence submitted by the Partnership to the Tobacco and Vapes Bill public bill committee.

1. Pass legislation to raise the age of sale for tobacco by one year, every year, to create a smokefree generation. Preventing future generations from becoming addicted to smoking will significantly benefit their physical and mental health.

• The generational smoking ban is necessary to reduce uptake of smoking in future generations, including those with mental health conditions. This will improve mental and physical health and wellbeing across the whole population and reduce the significant health inequalities experienced by people with mental health conditions.

2. Publish a roadmap to a smokefree country including a comprehensive strategy to eliminate the disparity in smoking rates between people with and without mental health conditions.

• Despite progress in reducing smoking prevalence in the general population, rates among people with mental health conditions remain stubbornly high. A national strategy is urgently needed to set out how the government will deliver its smokefree ambition, with explicit policy interventions and targets for those with poor mental health. The UK government should deliver on the commitment made in the Labour health mission to publish a roadmap to a smokefree country.

3. Fully implement commitments made in the NHS Long Term Plan to provide smoking cessation support to people with long term mental health conditions in inpatient and community settings.

• The NHS Long Term Plan committed to providing tailored stop smoking support to people with long term mental health conditions. This support is being delivered through tobacco dependence treatment services in hospitals. It is vital that these services are fully embedded and sustained long term. In practice, mental health settings have seen funding to deliver these services curtailed more than other areas such as acute and maternity, while funding for stop smoking support in community mental health settings has been cut completely. The commitment in the Labour manifesto to “integrate ‘optout’ smoking cessation interventions into routine care” is encouraging but the government must ensure that this covers both inpatient and community mental health services.

4. Ensure vaping products remain accessible to adults with mental health conditions for smoking cessation, including in inpatient care settings. NHSE and OHID should issue joint evidence-based guidelines to support decision making on vaping in NHS trusts and local stop smoking services.

• The Mental Health and Smoking Partnership strongly supports efforts curb youth vaping. However, this must not come at the expense of adult smokers who would benefit from using vapes to quit smoking. Vaping poses a small fraction of the risks of smoking in the short and medium term – although it is not risk free – and is recommended by NICE as a first line smoking cessation aid. Vapes appear to be just as effective and acceptable for smoking cessation among people with mental health conditions as the general population, although further research is needed.

• Vaping is increasingly well integrated into government funded stop smoking support across the NHS and local government. The NHS Long Term Plan specifically states that e-cigarettes will be used to support smokers in mental health settings. A recent survey conducted by ASH found that all mental health trusts permitted the use of vapes on adult mental health wards, including over three quarters of trusts (78%) providing e-cigarettes for free. These products have particular value for smokers with mental conditions, partly due to their low cost and ease of use compared to stop smoking medications. The latest annual Smokefree GB YouGov survey, commissioned by ASH, found that significantly more smokers with mental health conditions report using a vape during a quit attempt than those without (39% to 25%).

• The Partnership supports the powers set out in the Tobacco and Vapes Bill on vapes and nicotine products. However, the regulations must account for the role vapes play in (a) supporting people with mental health conditions to quit or abstain from smoking and (b) facilitating smokefree policies in hospitals.

5. Identify opportunities to address smoking among people with common mental health conditions such as anxiety and depression.

• Existing NHS support will not reach smokers with common mental health conditions such as depression and anxiety who are not in contact with secondary mental health services. These people tend to seek support from their GP and through the Talking Therapies programme (formally IAPT). Talking Therapies receives 1.69 million referral a year, a quarter of which are likely to be smokers. Smoking status is not routinely gathered, and cessation support is not built into the offer, despite these services providing support with other factors that impact mental health such as diet, sleep and exercise. Small scale studies have found that offering cessation support along regular psychological care, is feasible, acceptable and resulted in more quit attempts. The government should explore the potential to pilot stop smoking support in Talking Therapies on a wider footprint.

6. Challenge the myth that smoking reduces stress and anxiety through national comms activity and information in cigarette packs.

• The myth that smoking in some way relieves symptoms of poor mental health continues to be widespread, including among health professionals. The evidence is clear that smoking traps people in a cycle of addiction and withdrawal, increasing stress and anxiety and leading to higher rates of disruptive behaviour in secondary mental health settings. The Partnership has welcomed the government’s commitment to “require tobacco companies to include information on tobacco packaging that dispels the myth that smoking reduces stress and anxiety.” We recommend that the government goes further by integrating messaging about the negative impact of smoking on mental health and the benefits of quitting into national stop smoking mass media campaigns.