Tobacco and Vapes Bill

Written evidence submitted by the Mental Health and Smoking Partnership (MHSP) (TVB42)

Public Bill Committee on Tobacco and Vapes

Introduction

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 in the last parliament. It is coordinated by Action on Smoking and Health who receive funding from Cancer Research UK and British Heart Foundation.

Summary

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 the 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 is not appropriate for children or non-smokers and carries the risk of addiction. 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 ensure that they continue to be a viable stop smoking aid.

Smoking and poor mental health

4. Nearly half (45%) of those with a serious mental illness (SMI) in England smoke, alongside a quarter (26%) of people with depression or anxiety , compared to 1 1.6 % of the general population. 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]

5. There is a growing body of evidence that smoking causes poor mental health, particularly increasing the chance of developing bi-polar, schizophrenia and depression with a weaker link between smoking and going on to develop ADHD and anorexia. [2] [3] [4] 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 also impacts the brain.

6. Smoking also indirectly affects mental health through:

· Making people sicker and reducing their employment prospects.

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

· Trapping smokers in a cycle of addiction and withdrawal.

7. 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 increas es 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.

8. Despite this, the myth that smoking in some way relieves symptoms of poor mental health continues to be widespread, including among health professionals. We therefore welcome the government’s commitment to "require tobacco companies to include information on tobacco packaging that dispels the myth that smoking reduces stress and anxiety." We recommend that the government goes further by integrating messaging about the negative impact of smoking on mental health and the benefits of quitting into national stop smoking mass media campaigns.

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. [5] [6]

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   . Targeted action needs to be taken to prevent the most vulnerable falling even further behind.

Publishing a ‘ roadmap to a smokefree country ’

11. Recommendation: Publish a r oadmap to a smokefree country including a comprehensive strategy to eliminate the disparity in smoking rates between people with and without mental health conditions.

12. Despite progress in reducing smoking prevalence in the general population, rates among people with mental health conditions remain stubbornly high. A national strategy is urgently needed to set out how the government will deliver its smokefree ambition, with explicit policy interventions and targets for those with poor mental health. The UK government should deliver on the commitment made in the Labour health mission to publish a roadmap to a smokefree country. [7]

Using vapes to support people with mental health conditions to quit smoking

13. 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. [8] Vaping is recommended by NICE as a first line smoking cessation aid. 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]

14. In recent years vaping has become well integrated into government funded stop smoking support across the NHS and local government. The NHS Long Term Plan specifically states that e-cigarettes will be used to support smokers in mental health settings. [12] A recent survey conducted by ASH found that all mental health trusts permitted the use of vapes on adult mental health wards, including over three quarters of trusts (78%) providing e-cigarettes for free. [13] 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. 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%). [14]  

15. The Partnership supports the powers set out in the Bill on vapes and nicotine products. However, the regulations must account for the role vapes play in (a) supporting people with mental health conditions to quit or abstain from smoking and (b) facilitating smokefree policies in hospitals.

16. The P artnership ’s recommendations on vaping are set our below. Further detail and supporting evidence is included in the ASH submission on vaping.

17. Recommendation: The UK government should produce a policy note setting out their objectives in relation to vaping, how the deployment of new powers will support those objectives and how the impact will be monitored and approaches adapted, if necessary, over time.

18. Recommendation: Vapefree places regulations should include exemptions for settings where vaping is supporting people to quit and abstain from smoking. This includes local stop smoking services and NHS settings such as mental health settings, hospital grounds, smoking cessation clinics.

19. Recommendation: The government should consider including an exemption to the vending machine ban for healthcare settings where vapes are facilitating smokefree policies and smoking cessation.

20. Recommendation: NHSE and OHID should issue joint evidence-based guidelines to support decision making on vaping in NHS trusts and local stop smoking services.

January 2025