Health groups call for positive approach to e-cigarettes for smokers with a mental health condition

14 November 2017

A broad alliance of mental health and public health organisations today called for better understanding of the role electronic cigarettes can play as an aid for smokers with mental health conditions who want to quit. In its Statement on Electronic Cigarettes, [1] the Mental Health & Smoking Partnership [2] highlighted the need for wider acceptance of electronic cigarettes in mental health settings.

Both the NHS Five Year Forward View for Mental Health [3] and the new Tobacco Control Plan for England [4] emphasise the need for “parity of esteem” in tackling rates of smoking. However, smoking remains around twice as common among people with mental health conditions. [5] People with mental health conditions die on average 10 to 20 years earlier than the general population [6] and smoking is the single largest cause of this shocking disparity. [7]

The evidence shows that using electronic cigarettes smoking tobacco [8] but policies on electronic cigarettes use are inconsistent across mental health settings. A combination of nicotine replacement, such as with gum, patches or e-cigarette, when combined with behavioural support from a trained smoking cessation worker, makes quit attempts four times as likely to succeed. [9].

Professor Ann McNeill of the UK Centre for Tobacco and Alcohol Studies and co-chair of the Mental Health and Smoking Partnership said:  “People with a mental health condition are more than twice as likely to smoke as the general population. This is a great inequality leading to early death and years of chronic illness for many. E-cigarettes provide a new opportunity for people to move away from smoking and avoid the terrible burden of death and disease it causes.

“In publishing this statement we seek to address some of the widespread misunderstandings about e-cigarettes. It is hoped that it will support mental health staff and organisations in thinking about how they can encourage more of their service users to make the switch from smoking tobacco.”

Stopping smoking is one of the single most significant actions people can take to improve their health, including their mental health and reducing the risk of premature death. [10] Not only does physical health improve upon quitting, mood can improve too. Anxiety symptoms can decrease and smokers on some anti-psychotic medications who quit can sometimes reduce the dose of medication. [11]

Lesley Colley, Project Lead Smoking Cessation and Nicotine Management, Tees Esk and Wear Valleys NHS Foundation Trust: “Electronic cigarettes, along with Nicotine Replacement Therapies (NRT), have helped cut smoking rates from 42.5% to 28% in our Mental Health Trust since March 2016. Service users overwhelmingly requested the option to use electronic cigarettes during an in-patient stay and the Trust supported this by offering free disposable electronic cigarettes on admission. All types of electronic cigarettes are now permitted Trustwide.”

References

[1] Mental Health & Smoking Partnership statement on e-cigarettes

[2] A full list of Mental Health & Smoking Partnership members can be seen at http://smokefreeaction.org.uk/smokefree-nhs/smoking-and-mental-health/

[3] NHS England, Five Year Forward View for Mental Health. 2016

[4] Department of Health. Towards a Smokefree Generation: A Tobacco Control Plan for England. 2017.

[5] Public Health England. Local Tobacco Control Profiles. Original data from the Health and Social Care Information Centre: Smoking rates in people with serious mental illness. (By Clinical Commissioning Group) (Dataset 1.23)

[6] Chang CK. Hayes R. Broadbent M. Perera G. Fernandes A. Lee W. Stewart R. Life expectancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London. PLoS One. 2011; 6(5): e19590. 9.

[7] Royal College of Physicians and Royal College of Psychiatrists. Smoking and Mental Health, 2013.

[8] Royal College of Physicians. Nicotine without smoke: Tobacco harm reduction. 2016

[9] Public Health England website – https://campaignresources.phe.gov.uk/resources/campaigns/6-stoptober/overview

[10] Primary care guidance on smoking and mental disorders. Primary Care Mental Health Forum, 2014.

[11] NHS Choices website. Stopping smoking is good for your mental health. 2015