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Not enough being done to help smokers with mental health issues quit

Nearly one in five mental health trusts still don’t have comprehensive smoke-free policy in place despite deadline for implementation already having passed, says ASH

Caroline White

Friday, 08 November 2019

One in five mental health trusts still don’t have a comprehensive smoke-free policy in place, despite the government deadline for implementation having passed last year, says a progress report* issued by campaign group Action on Smoking and Health (ASH).

The report, which looks at how well mental health trusts have been working towards the government target of comprehensive smoke-free policies, draws on responses to an online survey of mental health trusts in England (83% response rate) on behalf of Public Health England.


Smoking prevalence among people with mental health conditions remains around 50% higher than among those without, but staff behaviour often enables smoking, with staff accompanying patients on smoking breaks every day in 57% of trusts, the report found.

In over half of responding trusts, patients weren’t always asked if they smoked on admission, and less than half (47%) of trusts offered patients the choice of combination NRT or varenicline in line with National Institute for Health and Care Excellence (NICE) best practice.

A further report into service users’ experiences of smoke-free policies, funded by Cancer Research UK, includes key practical recommendations for implementing such policies in a supportive and person-centred way.

Smoking killed 78,000 people in England last year and is the largest single contributor to the average 10-20 year reduction in life expectancy among people with mental health conditions, emphasises ASH.

The target in the government’s Tobacco Control Plan was for all mental health trusts to implement comprehensive smoke-free policies by 2018.

By 2019, four fifths of surveyed trusts (82%) had a comprehensive smoke-free policy in place. But even for those trusts with a policy, there is plenty more work to be done, says ASH.

Not all inpatients with mental health conditions are getting the support they need to quit smoking, despite NICE recommendations.

The report recommends that all trusts without a comprehensive smoke-free policy in place should implement one as a matter of priority, and that they should offer both combination NRT and varenicline to inpatient smokers, with behavioural support, to give them the best possible chance of quitting.

Mental health trust managers and smoke-free leads should work with ward managers and staff to audit and eliminate the time spent by staff escorting patients on smoking breaks, it recommends.

And smoking status should be routinely and consistently asked and recorded on a patient’s admission to acute mental health services, it says.

And local authorities should work with mental health trusts to ensure that people with mental health conditions in the community can access appropriate specialist support to enable them to quit, it says.

Ann McNeill, professor of tobacco addiction and co-chair of the Mental Health and Smoking Partnership said: “Helping people with mental health conditions to quit smoking is the best way to help them live longer.

“While we have seen smoking rates fall dramatically for the population as a whole over the last four decades, we haven’t seen the same decline for people with mental health conditions. More work needs to be done, including by mental health trusts providing support for smokers to stop smoking.”

She added: “At a minimum, trusts should ensure they meet the recommendations set out in NICE guidance and ensure they contribute to the government’s target for all mental health trusts to have a comprehensive smoke-free policy in place. Let’s stop smokers with mental health conditions from slipping through the gaps in the system.”


* Progress towards smokefree mental health services. A report prepared by ASH, October 2019. 

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