Tobacco and Vapes Bill

Written evidence submitted by the Mental Health and Smoking Partnership (MHSP) (TVB56)

Public Bill Committee on Tobacco and Vapes


1. The Mental Health and Smoking Partnership is a coalition of organisations committed to improving the health and lives of people with a mental health condition by tackling the high rates of smoking in this population. The partnership is jointly chaired by Professor Ann McNeill, Professor of Tobacco Addiction at the National Addictions Centre, King’s College London, and Mark Rowland, Chief Executive of the Mental Health Foundation who gave evidence to the Bill Committee. It is coordinated by Action on Smoking and Health who receive funding from Cancer Research UK and British Heart Foundation.


2. The Partnership strongly supports the tobacco measures set out in the Bill on raising the age of sale and greater regulation of tobacco products. Although smoking rates are going down in the general population, they remain stubbornly high among people with mental health conditions. Raising the age of sale is therefore vital to reduce the uptake of smoking among people with mental health conditions, but more needs to be done to support existing smokers in this group to quit to ensure they are not left behind.

3. The Partnership supports the powers set out in the Bill on vapes and vaping products (including those which don’t contain nicotine) and other nicotine products. Vaping may be detrimental to child health and carries the risk of addiction which can also impact mental health. However, vaping is an effective smoking cessation aid for adults and may have particular value for smokers with mental health conditions. As such, careful consideration should be taken when regulating vapes to minimise the risk of deterring smokers from using effective cessation aid.

Why it matters

4. Nearly half (45%) of those with a serious mental illness (SMI) smoke (1.6m), alongside a quarter (26%) of people with depression or anxiety compared to 13% of the general population. It's estimated that 1 in 5 people who smoke are currently in treatment for a mental health condition – the majority of these are people with depression and anxiety.

5. High rates of smoking among this population have a disastrous impact on physical health, particularly for those with a serious mental illness who on average live 15-20 years less than someone without. It is estimated that smoking accounts for two-thirds of the reduced life expectancy in this group. [1]

6. There is a growing body of evidence that smoking causes poor mental health , particularly increasing your chance of developing bi-polar, schizophrenia and depression with a weaker link between smoking and going on to develop ADHD and anorexia. [2] [3] It is not clear how smoking causes poor mental health. However, smoking is highly addictive and damages every organ in the body so it is unsurprising that it might impact on the brain.

7. Smoking also indirectly affect s mental health through:

· Making people sicker and reduc ing their employment prospects .

· Reducing household incomes and increasing the likelihood of living in poverty. Th e average smoker spends up to £2 , 500 a year on tobacco .

· Trapping smokers in a cycle of addiction and withdrawal.

8. These factors combined make smokers less financially secure which can result in stress, anxiety and depression, contributing to the burden of poor mental health. This traps people in a vicious cycle where smoking increasing the risk of poor mental health and poor mental health increases the chances of smoking and the number of cigarettes someone smokes. People with mental health problems tend to smoke far more, and that addiction then exacerbates psychiatric symptoms.

9. As with adults, smoking is several times more common in children and young people with mental health conditions and behavioural disorders. In 2017, children and young people in England aged 11–16 identified as having a probable mental disorder were 10 times more likely to smoke regularly than those without. [4] [5]

10. As a result of these inequalities , preventing future generations from starting to smoke will significantly benefit the physical and mental health of that generation. However, it will not do anything directly for the approximately one third of smokers with a mental health condition. T argeted action needs to be taken to prevent the most vulnerable falling even further behind.

How the Bill could go further

11. T his bill could go further i n helping to dispel the myth that smoking acts as a stress reliever or can help to improve mental wellbeing. This belief is prevalent among both smokers and even some mental health professionals : " Smoking is one of the most feasible coping strategies if you also need to look after a family, hold down a job etc. Smoking is accessible, easiest thing to do as a crutch that is legal ." (Mental Health Nurse, ASH & Bluegrass Qualitative Insights report) [6]

12. This myth has not come about by accident, the tobacco industry has deliberately commissioned research into the proposed impacts of smoking, looking for some sort of consequence for relieving long-term stress. [7] This misconception undermines progress towards improving the physical and mental health of our nation and allows people to justify a n addiction that is killing them.

13. There is good evidence that the opposite is true. A Cochrane review found that stopping smoking not only did not worsen mental health but was associated with moderate improvements to mental wellbeing. The effect was equivalent to that of taking anti-depressants. [8]

14. In 2022, t he Khan review recommended including inserts in cigarette packs which provide information on the health benefits of quitting. Pack inserts would be an ideal way to inform smokers about the link between smoking and poor mental health and dispel the myth that smoking helps to relieve stress. The Government consulted on this topic in August of last year but have not published a response. The Tobacco and Vapes Bill is an obvious route for introducing this measure.

Vaping and mental health

15. Evidence to date shows that vaping poses a small fraction of the risks of smoking in the short and medium term although it is not risk free. Vapes appear to be just as effective and acceptable for smoking cessation among people with mental health conditions as the general population, although further research is needed. [9] [10] [11] Anecdotal evidence from mental health services indicates that these products have particular value for smokers with mental conditions, partly due to their low cost and ease of use relative to stop smoking medications.

16. The latest annual Smokefree GB YouGov survey, commissioned by ASH found that significantly more smokers with mental health conditions report using a vape during a quit attempt than those without (39% to 25%). [12]   Additionally, adults with a diagnosed mental health condition were significantly less likely to be using vapes with tobacco flavours and significantly more likely to be using vapes with a fruit flavour. Nearly 60% (58%) of vapers with a diagnosed mental health condition are using fruit flavours compared to 45% of those without, with fruit flavours particularly common among those with neurodiverse conditions such as autism (71%). ASH also asked people what they would do if only a limited number of flavours were available and vapers with mental health conditions were more likely than other groups to report they would start smoking, smoke more or return to smoking than those without mental health conditions (16% versus 10%). Any restrictions on flavours would need careful consideration so as not to negatively impact those with mental health conditions.6


17. However, vapes should not be used by non-smokers and certainly not by children who are especially vulnerable to the effects of addiction. A Delphi study conducted by the Mental Health Foundation found that avoiding addiction was the number one thing people could do to safeguard their mental health. [13] Because of this, we support taking action to reduce the appeal or vapes to children in secondary legislation. This should include mandating plain packaging and used alphanumeric flavour descriptors.

May 2024

[1] Tam J, Warner KE, Meza R. Smoking and the reduced life expectancy of individuals with serious mental illness. American journal of preventive medicine. 2016 December.

[2] Wootton RE, Richmond RC, Stuijfzand BG, Lawn RB, Sallis HM, Taylor GM, Hemani G, Jones HJ, Zammit S, Smith GD, Munafò MR. Evidence for causal effects of lifetime smoking on risk for depression and schizophrenia: a Mendelian randomisation study. Psychological medicine. 2020 Oct.

[3] Vermeulen JM, Wootton RE, Treur JL, Sallis HM, Jones HJ, Zammit S, van den Brink W, Goodwin GM, De Haan L, Munafò MR. Smoking and the risk for bipolar disorder: evidence from a bidirectional Mendelian randomisation study. The British Journal of Psychiatry. 2021 Feb.

[4] Marcheselli, F. et al. Mental Health of Children and Young People in England, 2017. 2018. NHS Digital.

[5] Vizard, T. et al. Mental Health of Children and Young People in England, 2020. 2020. NHS Digital.

[6] ASH & Bluegrass Qualitative Insights. 2022

[7] Petticrew MP, Lee K. The "father of stress" meets "big tobacco": Hans Selye and the tobacco industry. American journal of public health. 2011 Mar;101(3):411-8.

[8] Taylor GM, Lindson N, Farley A, Leinberger-Jabari A, Sawyer K, te Water Naudé R, Theodoulou A, King N, Burke C, Aveyard P. Smoking cessation for improving mental health. Cochrane Database of Systematic Reviews. March 2021.

[9] O’Brien B, Knight-West O, Walker N, Parag V, Bullen C. E-cigarettes versus NRT for smoking reduction or cessation in people with mental illness: secondary analysis of data from the ASCEND trial. Tobacco induced diseases. 2015 December.

[10] Caponnetto P, DiPiazza J, Kim J, Maglia M, Polosa R. A single-arm, open-label, pilot, and feasibility study of a high nicotine strength e-cigarette intervention for smoking cessation or reduction for people with schizophrenia spectrum disorders who smoke cigarettes. Nicotine and Tobacco Research. 2021 July.

[11] Hickling LM, Perez-Iglesias R, McNeill A, Dawkins L, Moxham J, Ruffell T, Sendt KV, McGuire P. A pre-post pilot study of electronic cigarettes to reduce smoking in people with severe mental illness. Psychological medicine. 2019 April.

[12] Smokefree GB Adult survey 2024. Total sample size was 13,266 adults. Fieldwork was undertaken between 29th February – 18th March 2024. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+)

[13] The Mental Health Foundation. Groundbreaking study combines expert views, research evidence and public opinion to generate new mental health advice. October 2021.


Prepared 15th May 2024