Memorandum by Rethink (SP39)
We are pleased to have the opportunity of contributing
to this inquiry. Rethink is the charity for people who experience
severe mental illness and for those who care for them. We are
both a campaigning membership charity, with a network of mutual
support groups around the country, and a large voluntary sector
provider in mental health, helping 7,500 people each day. Through
all its work, Rethink aims to help people who experience severe
mental illness to recover a meaningful and fulfilling life and
to press for their families and friends to obtain the support
they need.
Rethink believes, after consulting with people
who experience severe menial illness and their carers, some of
whom smoke tobacco, that people with a severe mental illness should
be helped but not coerced into giving up smoking. We see smoking
as damaging to the health of tobacco smokers and to others around
them, but it needs to be accepted that giving up smoking is difficult
for most people and particularly difficult for a person who experiences
a severe mental illness. It's also the case that people with a
severe mental illness are more vulnerable to stress; an adverse
event may cause them to resume smoking.
You may be interested in the following, which
is taken from a literature search undertaken by Dr Ann McNeill
for a conference in 2001 organised by "Smoke Free London",
"Mentality" and "Action on Smoking and Health"
identified the following key issues:
— nicotine dependence is the most prevalent,
deadly and yet most treatable of all psychiatric disorders but
is often overlooked by the psychiatric profession;
— smoking prevalence is significantly
higher among people with mental health problems than among the
general population, highest amongst those with a diagnosis of
a psychotic disorder;
— people with psychotic disorders who
live in institutions are particularly vulnerable: over 70% of
this group smoke including 52% who are heavy smokers; more than
half wanted to give up smoking;
— daily cigarette consumption is considerably
higher among smokers with mental health problems who may also
inhale smoke more deeply;
— smoking related fatal diseases have
been shown to be commoner among people with a diagnosis of schizophrenia
than among the general population; some of the higher rate of
mortality of people with mental health problems is potentially
preventable if they are given support to stop smoking;
— nicotine may help alleviate some
of the positive and negative symptoms associated with psychiatric
illnesses and may also help to alleviate the side effects associated
with their medications;
— a significant proportion of people
with a diagnosis of schizophrenia recognise that smoking is a
problem, want to quit and will attend smoking cessation therapy;
— effective treatments exist to help
people stop smoking and are not yet being routinely offered to
people with mental health problems;
— all health professionals working
with smokers with mental health problems should encourage smokers
to quit and refer those needing further support to specialist
smoking cessation services;
— there is evidence from other countries
that smokers with mental health problems feel excluded from mainstream
stop smoking programmes;
— attempts to stop smoking do not appear
to exacerbate psychotic symptoms;
— many mental health institutions at
best condone and at worst encourage smoking; smoke-free policies
encourage smokers to quit, make non-smoking the norm and reduce
the harmfulness of environmental tobacco smoke; and
— in the UK, people with schizophrenia
who smoke contribute an estimated £1 39m each year to the
Treasury.
The Government is consulting on the Health Improvement
and Protection Bill from which we note that regulations may exempt
a range of premises, including those where we have a particular
interest, ie
— residential and nursing care homes;
— psychiatric hospitals and units;
— prisons or other places of detention;
and
— detention rooms in police premises.
Given the problems associated with mental illness
and smoking cessation, we believe that regulations will be needed
to exempt people with a severe mental illness living in these
types of accommodation for as long as people smoke. One possible
approach that may be acceptable is for people with a mental illness
to smoke outside, eg in a designated area like an inner courtyard,
but particular attention needs to be paid to compulsorily detained
patients who may be unable to leave the ward, who should still
retain the ability to smoke. We should like to take the opportunity
of advocating smoking cessation programmes for people with a severe
mental illness. In psychiatric hospitals, both staff and patients
live in a smoking environment, which is not helped by patients
being very bored during their stay in hospitals. Indeed, it's
not so long ago that cigarettes were offered to patients as an
incentive to behave well.
In April 2002, the National Institute for Clinical
Excellence (NICE) recommended the use of the drug, Bupropion and
Nicotine Replacement Therapy for smokers who wish to quit and
are motivated to do so.
Generally Rethink wishes for people with a severe
mental illness to be treated in the same way as other people,
free from the stigma and discrimination associated with mental
illness. It follows that we believe that they should be treated
in the same way as other people as regards smoking in public places.
However, we seek recognition of the problem of severe mental illness
and smoking that needs to be addressed by providing help to such
people to enable them to quit.
September 2005
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