Tobacco smoking is the prime avoidable cause of death and disease in the UK and a major contributor to health inequalities, with smoking prevalence significantly raised (and stagnating) among the most vulnerable and disadvantaged groups compared to the general population, where prevalence has been falling steadily over the last decades. Smoking rates among people with mental ill health are on average two to three times higher than among people without mental health issues, and can reach figures above 70% for certain subgroups, such as inpatients and patients with dual diagnosis. In addition, people with mental ill health tend to be more heavily addicted to tobacco, which typically results in high levels of cigarette consumption and disproportionate tobacco-related morbidity and mortality. It has been shown that patients with mental ill health consume over 40% of all cigarettes smoked in the UK and lose on average 17 years of life to their tobacco addiction (ASH report; ‘The Stolen Years’) despite the fact that they are generally as motivated to stop smoking as people without mental ill health, and that effective tobacco dependence treatment is available.
The causal links between smoking and mental ill health are complex and include neurobiological, genetic and psychosocial factors. These factors can pose challenges for change in this area. Notably, tobacco smoking has been deeply entrenched in UK mental health service cultures for many decades until relatively recently, when NHS Trusts implemented smokefree policies and important reports (Royal College of Physicians/ Royal College of Psychiatrists; ‘Smoking and Mental Health’) and NICE guidance (PH48) were issued to address the subject. Much effort has been undertaken in recent years to ensure people with mental ill health receive the same support to address their smoking as the general population, and progress has been made. However, the tobacco-related mortality gap, as well as gaps in the evidence relating to the most effective ways of providing evidence-based support in this population remain large.
This theme is concerned with closing the gaps in the evidence base, using applied health and policy research, including the development of complex interventions, with the aim to support the development of high quality, evidence-based, equitable services for people with mental ill health.