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Smoking is one of the most significant causes of poor physical health and is the single largest cause of premature death for people living with serious mental illness (SMI). In England, 40.5% of people living with SMI are smokers, compared to approximately 15.5% in the general population [1]. People living with SMI are also likely to smoke more heavily. Smoking increases the risk of various physical health conditions (such as cardiovascular disease, cancer and type 2 diabetes). In turn, these increase the risk of further mental ill health and reduce wellbeing and life expectancy.

Individuals living with SMI have failed to benefit from population efforts to reduce smoking. Smoking rates remain high across this population. This is despite a steady decline in the general population over the past 40 years. Innovation is required to unite sectors and healthcare settings to increase stop smoking advice coverage and interventions in the most cost effective and meaningful way possible.

Reducing smoking rates in people with SMI is probably the single most important activity to reduce the mortality gap. It is a national priority outlined in NHS Five Year Forward View, Five Year Forward View for Mental Health and Five Year Forward View for Public Health.

Creating change and addressing the unacceptable gap in life expectancy will require a whole-system approach. It will need to support the delivery of smoking interventions to address culture and stigma, screening rates, treatment rates and treatment efficacy. We also need to ensure interventions are implemented to prevent the uptake of smoking in the first place.  These would include providing information, extra support, training of professionals, smoke-free environments and role modelling non-smoking behaviour.

Recommended actions

We have developed key recommendations that will support system change and effectively address the serious mental illness (SMI) mortality gap. Follow the links for more information and tools to support you:

• Working better together
• Recording and sharing data
• Screening, interventions and treatment 

These recommendations are in addition to those stated under the main prevention section.

Helpful tools and resources

• Smoking cessation in secondary care: mental health services. Includes briefings and guidance for commissioners, National Institute for Health and Care Excellence (NICE) guidance, provider implementation documents and self-assessment tools
• Smoking cessation in secondary care. NICE guidelines
• NHS Acute Trust self-assessment tool – this tool breaks down the NICE guidelines to develop local action to reduce smoking prevalence and the use of tobacco
• Action on Smoking and Health (ASH) Website, including:
  • ASH smoking statistics ‘facts at a glance’
  • The Stolen Years: the mental health and smoking action report (2016)
  • Smoking and Mental Health Factsheet
• ‘Making Every Contact Count’. NHS England provides a framework and training to support all staff to contribute to this agenda. This is a framework that can be rolled out to involve more professionals or staff across government agencies and voluntary sector organisations to reinforce messages and interventions to reduce smoking.
• Make Every Contact Count- Healthy London Partnership Programme
• National Centre for Smoking Cessation and Training. Deliver programmes and smoking cessation programmes that are evidence based and provided by local services. Available on the website are online training modules, clinical tools, commissioning and secondary care resources, and tobacco control statistics.
• Mental Health Network, NHS Confederation briefing. Highlights the importance of addressing smoking in the mental health population – This briefing provides the background to smoking prevalence and the consequences for people with mental illness. It examines the evidence of what works to reduce harm from smoking for this group, and how providers are implementing the smoking ban in practice.

Related policy:

• ‘No health without mental health: implementation framework’. Encourages services to address mental health service users’ physical health and local public health campaigns to target people with mental health problems.
• Local Tobacco Control Profiles. Public Health England publish Local Tobacco Control profiles for each CCG, to help local government and health services to assess the effect of tobacco use on their local populations. This is particularly relevant for people with SMI.

References:

[1]   PHE Local Tobacco Control Profiles. Original data from the HSCIC: Smoking rates in people with serious mental illness.  (By Clinical Commissioning Group) (Dataset 1.23)

 

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Tagged: serious mental illness (SMI), stolen years

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