Falling through the cracks: Closing the gap in stop smoking support for people with common mental health conditions

Summary

This report examines the inequalities in smoking among people with common mental health conditions such as anxiety and depression.

It draws together evidence on smoking prevalence, barriers to quitting, examples of emerging practice, and sets out recommendations for national government, the NHS, local authorities and the voluntary sector to improve access to tailored support, strengthen partnerships and ensure people with mental health conditions are not left behind in efforts to create a smokefree country.

Findings

National leadership and coordination are needed to ensure consistency and scale

• While some local authorities are taking proactive steps to reach people with mental health conditions, progress remains uneven and locally driven. Further support from the Government and NHS England would help to improve the coordination and quality of local activity.
• The lack of robust national data on smoking among people with common mental health conditions limits effective planning, target-setting and accountability.

Local government has a key role in leading a system-wide approach to reduce smoking among people with poor mental health

• There is significant variation in the extent and quality of stop smoking support for this population.
• Local authorities are uniquely placed to lead a whole-system, population-level response to smoking among people with common mental health conditions. This goes beyond commissioning specialist stop smoking services, to shaping a coordinated local system in which every organisation plays a role in supporting this population to quit.

There are significant opportunities to integrate smoking cessation support into existing mental health services

• There is scope to increase quit attempts by providing smoking cessation support within existing mental health services, such as Talking Therapies.
• There is further opportunity for third sector providers of therapy and mental health support to provide stop smoking interventions.

Greater awareness of the link between smoking and poor mental health is needed

• Both the public and mental health professionals have limited understanding of the bidirectional relationship between smoking and poor mental health and the resulting cycle of dependency.
• National and local campaigns, alongside improved training for those providing smoking cessation and mental health support, are needed to raise awareness of the mental health harms of smoking and dispel the myth that smoking relieves stress.

Pharmacotherapies and vapes can boost quit success

• Vapes are being used to help people with poor mental health quit or reduce smoking, with evidence showing they are particularly valuable for this population.
• Pharmacotherapies, including varenicline and cytisine, are effective cessation aids, particularly when combined with behavioural support, and can be safely used by people with mental health conditions.

Recommendations

        National government

1. Publish a roadmap to a smokefree country, including a plan to address high rates of smoking among people with mental health conditions.
2. Develop a national toolkit on delivering support to people with mental health conditions in stop smoking services.
3. Fund wider roll out of smoking cessation support in Talking Therapies.
4. Fund a financial incentive scheme to boost quit attempts among people with poor mental health, building on the success of financial incentives for pregnant smokers.
5. Run national communication campaigns to increase awareness of the links between smoking and poor mental health and address the myth that smoking relieves stress.
6. Maintain all current funding for local stop smoking services and intervene to protect funding for NHS tobacco dependence treatment services.

7. Regulate vapes to reduce uptake among young people and non-smokers while ensuring vapes remain accessible as a quitting aid for adults who smoke, particularly those with mental health conditions.

   Local authorities

8. Develop local strategies to implement a whole-system, population-level response to smoking among people with common mental health conditions. This should include clear targets and accountability for delivery.
9. Build partnerships with local services that support people with high rates of smoking and poor mental health and ensure smoking cessation is embedded in existing support. This includes mental health services but also those providing family/income support, foodbanks, addiction support, social housing and homelessness. This should involve ensuring staff are trained in VBA and referral, and co-locating quit support within these settings.
10. Ensure stop smoking support is tailored for those with mental health problems, for example by upskilling stop smoking advisors to support people with poor mental health, providing access to digital support, and implementing cut-down-to-quit approaches and increasing quitting timeframes (e.g. from 4 to 12 weeks). This should be informed by lived experience and local needs.
11. Ensure people with mental health conditions have access to pharmacotherapy and nicotine vapes, as recommended by NICE. Local authorities should continue to facilitate access to vapes for NHS trusts and other services supporting people with high rates of smoking.

12. Develop evidence-based comms campaigns addressing the link between smoking and poor mental health. These should be run at regional level to maximise their reach.

    NHS

13. ICBs should engage with local government in the development of system-wide plans to address the high rates of smoking among people with common mental health conditions.

14. Reinstate the collection of data on smoking among people with common mental health conditions through the GP Patient Survey to address the current gap in national data and build a better picture of local population health needs.

    Third sector providers

15. Integrate stop smoking support into non-acute mental health care and other services for populations with high rates of smoking and poor mental health (e.g. homelessness and housing support, foodbanks, drug and alcohol support services, criminal justice services, refugee and migrant support services).
16. Build links with ICBs, local authority stop smoking services and the National Centre for Smoking Cessation Training (NCSCT) to upskill staff and establish clear referral pathways.
17. Put in place smokefree policies that support service users, staff and visitors to abstain from smoking. This should include provision of or referral to stop smoking support.