Lung disease, mental illness and smoking – what’s the story?

People with mental health problems die on average 16-25 years earlier than the general population.[1] Around one third of adult tobacco consumption is by people with a current mental health condition[2] with smoking rates more than double that of the general population.[3]

Action on Smoking and Health (ASH) has published a new report, ‘The Stolen Years’, which is endorsed by 27 health and mental health organisations and sets out recommendations for how smoking rates for people with a mental health condition could be dramatically brought down over the next few years.  The Primary Care Respiratory Society UK is one of those 27 organisations endorsing this important report.

So what has this got to do with respiratory disease?

Respiratory conditions are more prevalent in people with serious mental illness (SMI).[4]  Yet there is evidence that they do not get the same quality of care as people with COPD without an SMI – they are less likely to have spirometry done, and are less likely to have a COPD diagnosis based on spirometry. Moreover, they are less likely to benefit from screening and public health programmes.[5] So many people with mental health conditions are currently living with undiagnosed and untreated disabling and frightening breathlessness.

 Five year mortality is higher for people with COPD and serious mental illness – 28% for people with schizophrenia (vs 15% without SMI), and 19% for bipolar.[6]

Rates of smoking are higher in people with COPD, and in people with mental illness, so actively seeking out patients with respiratory disease and an SMI who smoke to support them to quit is important if inequities in care and outcomes are to be addressed. Such people may need more support than others to give up, but there is evidence that more than 50% of people with an SMI report wanting to quit.[7] 

ACTIONS:

• Ask about symptoms of COPD in people with SMI especially in those who smoke
• Consider the possibility of mental health problems in people with COPD who still smoke – ask screening questions for depression and anxiety.
• Make it a priority to support people with COPD and/or SMI to quit smoking – they may need more support than others.
• Ensure mental health teams consider quit smoking efforts and services to be their responsibility

Further reading on these issues:

• No Health without Mental Health, 2011, Department of Health - see HERE
• Smoking and Mental Health.  A joint report by the Royal College of Physicians and the Royal College of Psychiatrists, 2013 - see HERE
• Clearing the Air. King’s Fund 2006 - see HERE
• No Health without mental health Academy of Medical Royal Colleges 2010 - see HERE

And of course the PCRS-UK website has a wealth of guidance on helping people to quit smoking. https://www.pcrs-uk.org/smoking-cessation 

References

1. No Health without Mental Health, 2011, Department of Health
2. Smoking and Mental Health.  A joint report by the Royal College of Physicians and the Royal College of Psychiatrists, 2013
3. Health Survey for England, 2013
4. De Hert et al   Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care   World Psychiatry. 2011 Feb; 10(1): 52–77.
5. No Health without Mental Health, 2011, Department of Health
6. Hippisley-Cox J, Vinogradova Y, Coupland C, Langford G and Parker C (2006a) A comparison of survival rates for people with mental health problems and the remaining population with specific conditions. London: Disability Rights Commission.
7. Clearing the air   King’s Fund   2006

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