Tackling the Myths about Smoking and Mental Health

1. Tackling the Myths about Smoking and Mental Health Kate Alley Smokefree Minds

2. The Health Act 2006 Mental Health facilities were given a one year extension and went smokefree in July 2008. However resistance and resentment remains in some areas. If you want to work with this client group you may have to deal some negative attitudes.

3. Commonly held beliefs…... It is a human right to smoke. They can’t quit. Smoking is all they have. It’s cruel to tell them they should quit. They have much bigger problems to deal with than smoking. Quitting smoking will exacerbate their mental health symptoms. It’s better for them to smoke.

4. There is no such thing as a “human right” to smoke. It was a tradition that smokers were permitted to smoke in public places. Many smokers believe it is their right to smoke whenever and wherever they chose.This is not the case.

5. Article 1 of the UK Human Rights Act of 1998 states that: “everyone’s right to life shall be protected by law.”

6. The Northern Ireland Human Rights Commission considered the issue of smoking and human rights in 1995 and found that: “no treaty or other instrument defines a human right to smoke and the Commission does not accept the position, sometimes advanced by the tobacco lobby, that there is such a right.”

7. Qualified Human Rights Article 8 of the Universal Declaration of Human Rights provides the right to a private life. However this is a qualified right and does not override the protection of the health and freedom of others. Personal freedom is not an absolute if it has an impact on others. We have many laws which limit a person’s freedom if it infringes on the rights of others. e.g. drink driving or playing loud music at night.

8. A Clash of Rights? Smokers are at liberty to damage their own health. They are not entitled to poison another person. The right to be work or be treated in a hospital which has not been polluted by tobacco smoke overrules any perceived right to smoke. People can go outside if they want to smoke. They can’t go outside every time they need to breathe.

9. While we’re talking about rights The physical health of people in psychiatric care is often overlooked. Access to health care services is a RIGHT, not a privilege. This includes access to the Stop Smoking Services. The world is going smokefree. If mentally ill people continue to smoke, this will be yet another way in which they are marginalised from mainstream society. This will compound the already unacceptable health inequalities and social exclusion that they face.

10. They can’t quit No one’s forcing them to! BUT……. How do we know? Every person is unique. Does this mean “they” don’t want to? Or does it mean that they desperately DO want to but are biologically incapable of quitting? Does it mean that we shouldn’t even ask them if they want to quit? Sometimes offering people help is as important as them accepting it.

11. More about why they can’t quit • Mentally ill smokers may not be able to quit on their own – very few smokers can - but that is what the specialist support services are there for. • Evidence shows that mentally ill smokers want to quit smoking just as much as smokers in the general population. They need help. We need to give it to them. • Legal case in the US.

12. What could happen if they did quit... Apart from improved physical health……. Many of the drugs used to manage mental health conditions are affected by smoking. A smoker using clozapine can sometimes need double the dose of a person who does not smoke. Do people who use these drugs know this?

13. Smoking is all they have. Why do we accept that smoking is “all they have”. Don’t “they” deserve more? A person with a mental illness should have more to look forward to than a cigarette. The introduction of smokefree laws have highlighted a shocking lack of provision in psychiatric care. Why aren’t there other things to do while in the hospital?

14. ….or does smoking have them? Smokers with a psychiatric illnesses often believe that smoking is the only thing in their lives which they have control over. Are they in control? Or is the addiction in control of them. Do staff use cigarettes to control patients? The tobacco industry have developed extensive programmes for marketing cigarettes to the mentally ill. Have mentally ill people been manipulated? If a person gives up smoking, what could they have instead?

15. Smoking is expensive. What else could that money buy?

16. Could your service help? Does your service offer incentives to quitters? Could these be offered to smokers using the psychiatric services. Goals are important in psychiatric healthcare. Could your service join forces with another service in your PCT to fund exercise classes for smokers trying to quit?

17. They have much bigger problems to deal with than smoking. Smoking-related illnesses are an unacknowledged problem. Mentally ill smokers are just as susceptible to smoking-related illnesses as other smokers. Smoking-related illnesses don’t just affect old people. Mouth and throat cancer generally strike smokers in their 30s and 40s. How would a person with schizophrenia or severe depression cope with a diagnosis of lung or mouth cancer? Bring out every scary picture you can find.

18. www.ash.org.uk

19. Not all smoking-related illnesses are life threatening. Smokers are more susceptible to: Pneumonia, cold and flu, bronchitis, influenza Dental problems including gum disease Type II Diabetes Peripheral Vascular Disease Losing their sight and/or hearing Impotence

20. Don’t assume they know the statistics traffic accidents (3,439) poisoning/overdose (881) alcohol liver disease (5,121) murder/manslaughter (513) Variant CJD (app 50) suicide (4,066) AIDS (234) illegal drugs (1,456) other accidental deaths (8,579) Over 100,000 smokers die every year of a smoking- related disease. Half of all life-long smokers will eventually die of a smoking-related illness. This figure is more than four times higher than the 24,289 deaths every year* arising from: * Figures from 2002

21. Scary secondhand smoke facts The US Environmental Protection Agency classified environmental tobacco smoke as a Class A carcinogen, alongside asbestos and benzene. SCOTH Report: secondhand smoke “represents a substantial public health hazard……...it is evident that no infant, child or adult should be exposed.” (published in 2004) Regular exposure to secondhand smoke increases a non-smokers risk of lung cancer by 24% and heart disease by 25%. A study of nurses in the US found that those who worked in smoky wards had a 91% increased risk of coronary heart disease. (Kawachi et al, 1997).

22. “An hour a day in a room with a smoker is nearly 100 times more likely to cause lung cancer in a non-smoker than 20 years spent in a building containing asbestos.” Professor Sir Richard Doll Professor of Medicine, Oxford University

23. Quitting smoking exacerbates mental health symptoms. It’s better to smoke. Studies have shown that smoking increases the likelihood of depression.(Wu & Anthony, 1999, Johnson et al. 2000) Smoking increases the risk of suicide among those with existing depressive illness. (Oquendo et al 2004) Smoking exacerbates stress (Parrot, 1989), anxiety (West and Hajek, 1997) and sleep disorders (Htoo, 2004) – all of which will be detrimental to patients with a mental illness. Other research demonstrates a link between smoking and the onset of panic attacks, panic disorder, and agoraphobia, along with an exacerbation in the severity of existing panic disorders(Zvolensky, 2005) Talk about nicotine withdrawal. Smoking doesn’t help with symptoms, it causes them!!!!

24. Effects on Mental State Cessation can increase the risk of a depressive episode. (Glassman et al. 2001) • Is this a reason not to offer quit support? • Does the risk of a depressive episode outweigh the risks of smoking? • Would a diagnosis of lung cancer lead to a new depressive episode? • Is smoking an effective way of maintaining mental health? • Continuing to smoke prevents a person from developing other strategies for coping with life.

25. Should hospitals facilitatea life-threatening addiction? Many have argued that smoking is facilitated within psychiatric care. (Lawn & Pols, 2005, McNally et al, 2006). If health professionals don’t appear to care about smoking, how can we expect the patient to recognise the dangers? Smokers who enter general hospitals often quit during their stay. Non-smokers entering psychiatric facilities often come out with a smoking habit. This is not right.

26. You can change someone’s life Former smokers often say that quitting smoking is the best thing they’ve ever done. Don’t assume mentally ill smokers don’t want to quit. For psychiatric patients, going without a cigarette for even a day can be a significant achievement. Quitting might be the only thing they’ve achieved in their life. Never underestimate how important that is, not just for someone’s physical health but for their self esteem.

27. Nothing worth doing is easy Working with this client group can be challenging but ultimately very rewarding. If you work in public health because you want to make a difference in people’s lives then this is the area for you!

28. Join the International Network on Smoking and Mental Health. http://www.publichealthzone.net/network/index.html