The vicious cycle of tobacco use and mental illness – a double burden on health

A new factsheet launched by WHO examines the intricate connections between tobacco use and mental illness. The factsheet stresses the urgent need to address these connections: 2 in 3 people with severe mental health conditions are current smokers, which has an enormous impact on health. Reducing smoking among people with mental illness is identified as the single most effective action for reducing the gap in life expectancy.

A double burden on health

The factsheet identifies a feedback loop between mental ill health and tobacco use. Mental illness makes people twice as likely to use tobacco and, at the same time, tobacco makes people more vulnerable to mental health concerns.

The relationship between tobacco use and mental health is complex and eye-opening. Some figures released in the factsheet are shocking – people with severe mental health conditions die on average 15–20 years prematurely, with tobacco cited as one of the main causes of death.

The impact of tobacco use is not limited to mortality rates, but also affects quality of life and attempts to cope with poor mental health. For example, tobacco reduces the effectiveness of certain medications for mental health. Conversely, quitting tobacco can allow people on certain antipsychotic medications to reduce the dosage by up to 25%.

Taking a myth-busting approach, the factsheet is packed with striking statistics drawn from up-to-date research. It foregrounds how essential it is for public health systems to support people with mental illness to quit tobacco. In addition to benefitting physical health, cessation can lead to numerous improvements in mental health, such as reduced levels of depression, anxiety and stress; enhanced mood; and even improved symptoms of attention deficit hyperactivity disorder (ADHD).

Challenges ahead

The tobacco industry is well aware of the connections between mental health and smoking. The factsheet outlines a number of strategies it uses to feed tobacco addiction among some of the most vulnerable in society. The list is long, from funding research that wrongly suggests quitting is extremely difficult for those with mental health conditions, to donating cigarettes to mental health facilities.

Even without the tobacco industry attempting to block progress, there are unique cessation challenges for people with mental illness. For example, people with mental health disorders are at higher risk of addiction, particularly as nicotine can temporarily mask the negative symptoms of mental disorders. Mental health conditions also often intersect with social determinants of health that can challenge successful quitting, such as stressful living conditions and low annual income.

However, these difficulties are not insurmountable. People struggling with mental ill health and tobacco addiction deserve sensitivity and support in quitting tobacco for good. This information should redouble policy-makers’ resolve to help people facing the twin struggles of mental illness and tobacco addiction.

Building a better world

More must be done for mental health across the board. This was the motivation behind a pan-European coalition on mental health that WHO/Europe recently launched to address gaps in provision and push mental health higher up on the policy agenda.

But to really help those with mental health conditions, interventions must be multifaceted. “Mental health intersects with many other health burdens,” says Ledia Lazeri, WHO/Europe’s Regional Adviser on Mental Health. “If we are to build a world that secures better mental health for everyone, we must build it on all fronts. That includes tobacco control.”

The factsheet provides guidance on appropriate policies to help those with poor mental health take steps towards tobacco-free lives. These include introducing smoke-free mental health  services, running awareness campaigns for both patients and health workers, training mental health staff and raising taxation on tobacco.

Presenting a cluster of interventions, the factsheet emphasizes the need to ratify and implement the WHO Framework Convention on Tobacco Control in full, ensuring that no gaps remain in the provision of care for tobacco users with mental illness.