Prior to coming to work for ASH Scotland I was an Addictions worker, latterly working in the community after a 18-month spell working in Saughton jail (sorry, HMP Edinburgh as it is now known). I supported people with drug and/or alcohol misuse problems and my job was to help them construct a recovery plan to address their particular issues, apply psychosocial support and refer to NHS specialist services and other third sector services if required. 97% of my average caseload of 35 people smoked tobacco and whilst we nearly always acknowledged a desire by some to quit smoking by writing it into their Recovery Plan, the truth is that action on this was parked at some distant point in the future and actually never addressed.

Why was this important issue never addressed by taking some action? There are three main reasons in my opinion.

  1. Service Users usually believed, (and Support Workers went along with it) that they would have to deal with their drug and/or alcohol problem first, “…one thing at a time…” and that stopping smoking would just cause anxiety and stress which would negatively impact on their efforts to get clean/sober.
  2. Addiction services are never contractually obliged to deal with smoking tobacco; there are no stated outcomes in their Service Level Agreement for this and with funding being tight and achieving stated outcomes paramount in order to get the contract renewed, why would you divert resources to dealing with smoking?
  3. Smoking tobacco is not considered an addiction in the same way as drug and alcohol.

If I take the last point first, my reasons for believing this is the way we deal with smoking tobacco as opposed to dugs and alcohol. Drugs and alcohol policy and legislation is embedded in all the mechanisms of public policy and planning in a way that tobacco is not. For example, the Edinburgh Partnership Community Plan 2015-2018 which describes the strategic priorities for the city in economy, jobs, health and wellbeing, young people and safer communities and should link to Scottish Government national outcomes, the word “alcohol” appears 35 times, “drug” 23 times and tobacco/smoking….well they are never mentioned at all. You’ll find mentions of drugs and alcohol mostly in the section about health and wellbeing but they also appear in sections on; improving early support, strategic themes for focused attention, improving outcomes for children and young people and creating safer communities.

It is quite right that government at all levels deal with the effects of drug and alcohol addiction, but why is nicotine addiction not given the same force of public planning and action? Here are some figures. In 2016 there were 867 drug-related deaths, there were 1,265 alcohol-related deaths but there were over 10,000 smoking-related deaths.

We know that smoking contributes enormously to inequalities in our society, not just in health but also financially and in life chances generally so why is nicotine addiction not afforded the same level of resources as alcohol and drugs? Whilst there are strong and influential Peer Mentor and Recovery movements in the drug and alcohol arena, there is nothing like this the many more people who are addicted to nicotine.

Of course the Scottish Government does take this issue of the harm caused by smoking tobacco seriously. They recently included an action point on smoking in the latest 10-year mental health plan, they are in the process of forming a new Tobacco Strategy, the NHS funds smoking cessation services in the community, in Pharmacies, on-line and on the phone (Smokeline 0800 84 84 84) and they also fund the IMPACT Project.

I would like to see the following happening to raise the profile of the issue of the harm caused by smoking tobacco.

  • Get major funders of services, particularly local authorities to include outcomes for numbers of people accessing smoking cessation and actually quitting smoking in contracts to service providers.
  • Get service providers to ask questions about smoking in their assessment processes and continue this into their planning and review services.
  • Get local authorities to start to include actions on smoking in their three year Partnership Community Plans and recognise that smoking does not just impact on health and wellbeing but into other areas of strategic concern also.

In terms of the first point. If you are already providing support to help someone overcome an addiction to substances, why not deal with all the substances? Would you advise someone with an addiction to eating to cut out the chips but carry on with the sweeties meanwhile, you know, “ thing at a time…” Also we know that smoking causes anxiety, the only thing it relieves is withdrawal from nicotine (see page 4-5 of the IMPACT Guidance)

For point two get all public services and publicly funded services to ask people about their smoking whenever they are applying for something or being assessed for a service. It would be voluntary, people would not be obliged to answer but if they did and confirmed that they smoke tobacco it opens the door for some brief advice, handing out some information and signposting to smoking cessation services. Even if a small percentage of the people who use these services then accessed smoking cessation support, it would greatly increase the numbers who successfully quit.




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