Smoking and Mental Health: a Neglected Epidemic


Jim O’Rorke, Mental Health Engagement Officer ASH Scotland
The above is the title of a report completed by The IMPACT Project in 2015. This document aspired to provide a broad overview of the evidence on smoking and mental health issues and was aimed at public health professionals and policy makers.

My Experience of Smoking and Mental Health
I’ve come to work for ASH Scotland on the IMPACT Project, which provides important information on the effect of smoking on mental health; information which I, as an experienced Support Worker was unaware of before I came here.
My own work experience prior to coming to ASH Scotland had been in addictions and mental health services in the voluntary sector for many years. Mental Health services I worked in included housing support, supported employment and community support. As an addictions worker I supported people with drug and/or alcohol problems onto and through their recovery journeys and usually through their lapses and relapses. The thing that many people had in common apart from addiction was that most of them had mental health problems also.

The great majority of people I worked with in these services smoked, and yet services did very little to help people deal with this. Why? Well two excuses were usually paraded by me as a worker and by medical professionals also. For people with mental health problems it was,
“…well the stress of trying to give up smoking will just make (whatever mental health problem the person had) worse! So we’ll acknowledge that it’s not good for your physical health and promise to help you deal with it at some indeterminate point in the future.”
For people with addictions issues it was,
” …well, one thing at a time! Let’s deal with your drug/alcohol problem first, and then we can see about the fags.” Again it would be noted in the recovery support plan for some distant date, but never addressed.

What didn’t help was that individuals themselves would say that although they knew it wasn’t good for their physical health, as far as their mental health went, smoking helped calm them down, feel less anxious; you might even say that it was helping.

The Report
So back to the report. In a review of the first year of the IMPACT project some startling and shocking statistics were identified from the research.
• One third of all tobacco smoked in the UK is used by people with mental health problems.
• People with mental health problems are dying 10-20 years earlier than the general population and smoking is a major contributory factor in this.
• People with mental health problems who smoke are just as motivated to quit smoking as the general population.

But perhaps the most startling fact for me, as someone who had supported people with mental health problems for many years, was that tobacco smoke can affect how well various psychiatric medications work so that a person has to take higher doses to achieve the same effect in someone who did not smoke. The NHS estimates that this costs an additional £40million per year across the UK.

I know that some people I supported reported side-effects from anti-psychotic medications in particular. Whilst they would acknowledge the benefit they received from taking this medication many would have at least considered stopping smoking if it meant they might be able to reduce their dose.

Over the last three months I have visited over 40 voluntary sector organizations across the Lothian’s who provide services to significant numbers of people who have mental health problems and spoken to hundreds of workers. None of the people I spoke to were aware of the effect of tobacco smoke on some commonly prescribed psychiatric medications. All of them believed that some of the people they support would be more motivated to stop smoking if they were aware of that fact.
The IMPACT Project
The IMPACT Project and the IMPACT Support Pack are valuable information and advice resources for anyone providing support to someone with a mental health problem who also smokes tobacco. If people are more aware about the effects of smoking on mental health and the various supports available to help them stop smoking, they might be more motivated to take the decision to stop. The IMPACT Project wants to support people to have an informed conversation about smoking and mental health.
The IMPACT Project has put together a free short training course for workers and others supporting people with mental health problems. This includes a one hour e-learning module to be completed before a two hour face-to-face session. We will be offering this training at ASH Scotland offices at 8 Frederick Street Edinburgh on the following dates between 10am and 12pm;
• 31/1/18
• 20/2/18
• 22/3/18
You can book directly through the IMPACT website
The IMPACT team will also be happy to visit organizations to deliver the training, please contact us to discuss this.

IMPACT Guide. Not just for workers

The IMPACT Guide was developed with paid support workers in the third sector in mind. It is recognized that many service users form good and confident relationships with workers and are more likely to trust the advice they give them. The Impact Guide tells us about the important role that support workers take in passing on accurate information about the effects of smoking on mental health which will motivate some people to think about stopping smoking and perhaps taking some action.

It’s not just paid workers however providing essential support to people with mental health problems, there are many volunteers, peer mentors and carers providing essential care on a daily basis. I found this out recently when I was asked to give a presentation to a group of people who are carers for people with mental health problems by Carers of East Lothian who run a range of monthly support groups for carers across East Lothian. The folk who attended were really interested in the information contained in the guide. One carer in particular was very concerned about the amount of tobacco her son smoked and felt sure that he would be interested in what the guide had to say, especially the Psychotropic drugs affected by smoking status information.

This information in particular has raised a lot of interest in those who are introduced to the guide for the first time.

So whatever your role in supporting people with mental health problems, the Impact Guide will provide you with essential information about the effects of smoking on mental health.


Jim O’Rorke

Mental Health Engagement Officer

Dates available for IMPACT training sessions

The first dates for the free open sessions for the IMPACT training course, “Smoking and Mental Health – Understanding the IMPACT”, are announced.

Open sessions will be available from the ASH Scotland office at 8, Frederick Street Edinburgh EH2 2HB. These sessions will be attended by people from many different organisations across the Lothians on the following dates:

Wednesday 31st January 2018
Tuesday 20th February 2018
Thursday 22nd March 2018

The session will start at 10am and finish at 12pm, with refreshments available from 9.30am

If you would like to register to attend one of the free sessions, please contact Clair Kirkwood on 0131 225 4725.

Please note that our training room is situated on the first floor of our building. As this is in a listed building, there is no lift access available and people with some health problems or disabilities may have difficulty accessing this room.  Please contact us if you have any questions about these restrictions.

IMPACT on the Road

Over the last three months I have been visiting third-sector organisations across the Lothians and Edinburgh; 39 in total. Most of these organisations would not consider themselves as primarily mental health services but as providing services in the following areas: homelessness, community health, employability, supported employment, vocational training, addictions, physical recreation, young people, learning disability, volunteering, veterans, deaf/hearing impaired, children and families, carers, domestic abuse/violence. What they have in common is significant numbers of service users who report that they have, or are, experiencing mental health problems.

It’s been a real pleasure and privilege to visit so many organisations providing vital services in or to their communities. As well as workers I have met peer mentors, volunteers and carers and they have all expressed interest in what the IMPACT Support Pack has to offer them in terms of having informed discussions with their service users about the effect of smoking on mental health.

From December a short e-learning (one hour) and a face-to-face training session (two hours) will be available to complement the information that is in the guide. Like the guide, these are free to  interested organisations. If I have visited you already I will be contacting you again nearer the time about the training. If I have not been out to see you yet, please contact me here.

This website now contains some resources which you may find useful when having that conversation about smoking and mental health. If there are other resources that you feel may be of use to you, please let me know. Another excellent source of information is the ASH Scotland website. In particular I recommend the one-page “Fast Facts” which cover a large range of topics connected to tobacco, particularly its adverse effect on physical and mental health.

Jim O’Rorke

Mental Health Engagement Officer