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Smoking and mental health

Welcome to our briefing on smoking and mental health.

A health inequalities gap that needs to be urgently addressed

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People with mental health and substance misuse issues smoke more cigarettes per day, are more addicted to nicotine and, although they are just as likely to want to give up smoking as others who smoke, they find it harder to quit.

In 2019, 31% of 230,000 people with a long-term mental health condition in Scotland smoke, a group with one of the highest smoking rates in society.

40-50% of people with mental health issues in Scotland’s most deprived communities (SIMD1) smoke, in contrast to 10% or fewer in our least deprived communities (SIMD5).

People who smoke tend to have lower mental wellbeing scores compared to former or non-smokers.

A man sits on the ground with his knees up to his chest and his arms wrapped around his legs. He has a sad look on this face, and there is a grey cloud above his head.

Inequalities people with mental health issues face due to tobacco

People with mental health issues are much more likely to develop non-communicable diseases such as cancer, cardiovascular and pulmonary diseases. Smoking is the largest preventable factor of non-communicable diseases, but the risk of developing certain types of cancer is halved 5 years after quitting smoking.

Smoking tobacco kills half of lifelong regular smokers, with an average loss of 22 years of life.

The cost of smoking-related diseases among people with mental health issues was estimated to be £719m in the UK. Based on population share, this is around £57.5m in Scotland.

Smoking is a heavy financial, as well as health burden for individual people. On average, a smoker in Scotland consumes 12 cigarettes per day and spends £3,341 per year, and this annual cost rises to more than £5,570 for those who smoke 20 cigarettes a day.

Smoking tobacco kills half of lifelong regular smokers, with an average loss of 22 years of life.

Research looking at the social care needs of smokers found, on average, they needed care and support 9 years earlier than ex-smokers and those who had never smoked.

A 1% reduction in the smoking prevalence in SIMD1 would save people £43.5m in tobacco expenditure.

Mental health problems are independently associated with average reduced life expectancy

9-20 years for bipolar disorder
10-20 years for schizophrenia
between 7-11 years for recurrent depression

Adding smoking to this burden further reduces quality of life and shortens life expectancy.

Smoking can affect the metabolism of medications such as some anxiolytics and antipsychotics, tricyclic antidepressants, commonly prescribed for people with mental health issues.

Smoking cessation

A 2016 meta-analysis found that many mental health professionals hold attitudes and misconceptions that may undermine the delivery of smoking cessation interventions.

40-45% hold negative
attitudes to smoking cessation or permissive attitudes to smoking.
51% believe patients are not interested in giving up smoking.
38% that quitting is too much for patients.

A 2021 Cochrane review showed that people with mental health issues who quit smoking saw greater reductions in anxiety and depression and improvements in positive feelings and mental wellbeing compared to those who continued to smoke.

On average, 62% of all people who make a quit attempt don’t use any quit aids. Using a tailor-made quit plan from specialist cessation practitioners, such as those available via NHS 24’s Quit Your Way Scotland and local smoking cessations services provide the highest chance of success.