1. Qasim Chowdary, Tobacco Control Manager, Public Health England
Smoking and Mental Health Towards a smoke-free generation, where no one is left behind
Qasim Chowdary, Tobacco Control Manager, Public Health England

2. A consensus for urgent action
DH - Towards a smoke-free generation: tobacco control plan for England ASH - The Stolen Years Care Quality Commission - Brief guide: Smokefree policies in mental health inpatient services The Mental Health and Smoking Partnership National Centre for Smoking Cessation and Training - Smoking Cessation and Mental Health: A briefing for front-line staff NHS RightCare - Smoking cessation decision aid RCPsych - Improving the physical health of adults with severe mental illness: essential actions
DH - Improving the physical health of people with mental health problems: Actions for mental health nurses
PHE - Smoking cessation in secondary care: mental health settings
NICE - Innovative ways to support smokers requiring nicotine management in a mental health organisation
PHE - Tobacco-free NHS – the journey for one London trust
PHE - How one mental health Trust in Leicestershire is using e-cigarettes as a tool to go smokefree
PHE - Health Matters: preventing ill health from alcohol and tobacco use
Smoking and Mental Health

3. Adult smoking rates in England
Source: Local Tobacco Control Profiles
Smoking and Mental Health

4. The second lowest smoking rates in Europe
Smoking and Mental Health

5. Smoking prevalence in England
Source: Action on Smoking and Health, The Stolen Years
Smoking and Mental Health

6. Smoking prevalence in adults with Serious Mental Illness (SMI)
Even in areas with relatively low adult prevalence, smoking in those with SMI remains high
Source: Local Tobacco Control Profiles
Smoking and Mental Health

7. Smoking rates and average reduced life expectancy by mental health problem
Source: Action on Smoking and Health, The Stolen Years
Smoking and Mental Health

8. Around 1 in 3 cigarettes in Britain is smoked by someone with a mental health problem
Around 1 in 3 cigarettes in Britain is smoked by someone with a mental health problem: source RCP RCPsych 2013
Sources: 1. West, Brown, Beard et al (2015) 2. McManus et al (2010) NCSR. 3. Wu C-Y et al. (2013). PLoS ONE 8(9): e Cookson C, et al (2014) BMC Health Services Research 2014, 14:304
Source: Mental Health & Smoking Partnership response to the House of Commons Committee on Science and Technology Inquiry into e-cigarettes
Smoking and Mental Health

9. Government’s Tobacco Control Plan for England
Smoking and Mental Health

10. A national ambition
Smoking and Mental Health

11. More than just “smoke outside”
Parity of esteem: supporting people with mental health conditions
Reduce the prevalence of smoking in people with mental health conditions.
Smoking prevalence may be declining year on year nationally, but in our journey towards a smokefree generation, we risk leaving some people behind. 40.5% of adults with a serious mental illness smoke44 and people with a mental health condition die on average 10 to 20 years earlier than the general population Smoking causes premature death, disability and poverty and if we do not reduce smoking prevalence among this group, we will have failed to reduce inequalities.
People with mental health conditions want to quit smoking as much as other smokers do 47, yet health professionals can be reluctant to offer them stop smoking support48 . Some professionals mistakenly believe that stopping smoking could negatively affect their patients’ mental health, when it can actually reduce symptoms of anxiety and depression49.
People with mental health conditions have an equal right to be asked whether they smoke. They need to be offered effective methods to quit smoking or reduce harm as part of their care plan and there is an urgent clinical need to improve the support they receive. In some instances, healthcare staff will escort patients on and away from hospital grounds to smoke. This practice is outdated. It reduces the resources available to deliver clinical care50 and causes direct harm to patients.
We are committed to implementing comprehensive smokefree policies, including integrated tobacco dependence treatment pathways, in all mental health services by For any hospital setting, becoming smokefree is more than simply telling patients, staff and visitors where they can and cannot smoke. It is about Trusts working to end cultures in which smoking is used as a way to build relationships with patients or whereby cigarettes and smoking breaks are used as incentives or rewards. It also includes increasing the availability of a full range of evidence-based treatment options to support quitting or temporary abstinence for patients and staff34 51 and encouraging staff to act as role models.
The majority of mental health provision takes place in the community and, if we are to achieve our ambition and reduce inequalities, urgent action is needed in these settings. Primary care and community care providers are fundamental in delivering an integrated tobacco dependence treatment pathway. This includes the systematic identification of smokers, provision of advice and access to effective support to quit or reduce harm. Shared ownership and responsibility in the local health and social care system is essential to ensure the continuity of care between primary, community and inpatient settings.
Smoking and Mental Health

12. Smokefree NHS
Smoking and Mental Health

13. CQUIN : Preventing ill health by risky behaviours
Indicator
Value
Preventing ill health by risky behaviours – alcohol and tobacco
Goal: To support people to change their behaviour to reduce the risk to their health from alcohol and tobacco.
0.25%
Action
(Smoking)
Timescale
2017/2018
2018/2019
Community Trusts 
Mental Health Trusts
Acute Trusts
Smoking and Mental Health

14. NHS RightCare Pathways
NHS RightCare Pathways are developed in close collaboration with NHS England’s National Clinical Directors, patient groups, Public Health England, Royal Colleges, and other key stakeholders. For each topic NHS RightCare Pathways aim to provide:
a high-level overarching national case for change;
priorities for improvement and key high impact interventions along a pathway
underpinning guidance and evidence
implementation resources to help make change on the ground; and
practice examples that show the potential in population health approaches.
By focussing on doing the right thing, and doing it consistently for the right people, NHS RightCare Pathways support improving population health and making optimal use of our collective investment in the health of our population..
For more information visit
Smoking and Mental Health

15. Leading Change, Adding Value: A framework for nursing, midwifery and care staff
Supporting tool: Mental health deep dive self-assessment tool
Smoking and Mental Health

16. Care Quality Commission - Brief guide: Smokefree policies in mental health inpatient services
‘CQC inspections should not challenge smokefree policies, including bans on tobacco smoking in mental health inpatient services (for example, by raising such policies as a unwarranted ‘blanket restriction’). Instead, focus should be paid on whether such a ban is mitigated by adequate advice and support for smokers to stop or temporarily abstain from smoking with the assistance of behavioural support, and a range of stop smoking medicines and/or e-cigarettes. Inspections should also consider whether alternative activities are in place and promoted, including regular access to outside areas.’
Mental health care providers have a duty of care to protect the health of, and promote healthy behaviour among, people who use, or work in, their services. This includes providing effective support to stop smoking or to temporarily abstain from smoking while using or working in secondary care inpatient services1.
Services are increasingly mandated by their commissioning authorities to implement comprehensive smoke-free policies, where smoking is banned within the whole hospital estate and tobacco dependence treatment pathways are integral to service provision. Smokefree policies might be perceived as contentious, particularly in services where there is a lack of support to effectively manage nicotine withdrawal and provide a range of alternative activities. However, in response to legal challenges, the Court of Appeal has ruled that smokefree policies do not infringe human rights.
CQC inspections should not challenge smokefree policies, including bans on tobacco smoking in mental health inpatient services (for example, by raising such policies as a unwarranted ‘blanket restriction’). Instead, focus should be paid on whether such a ban is mitigated by adequate advice and support for smokers to stop or temporarily abstain from smoking with the assistance of behavioural support, and a range of stop smoking medicines and/or e-cigarettes. Inspections should also consider whether alternative activities are in place and promoted, including regular access to outside areas.
Source: Care Quality Commission, Brief guide: Smokefree policies in mental health inpatient services
Smoking and Mental Health

17. Smoking rates in people with a mental health problem
Source: Action on Smoking and Health, The Stolen Years
Smoking and Mental Health

18. Thank you
Smoking and Mental Health