Smoking, mental health and serious mental illness (SMI)

Most adults in the UK are aware of the physical health risks of smoking tobacco, but research shows that smoking also affects people’s mental health and in particular linked to stress, anxiety, depression and schizophrenia.

Many patients with SMI do not access mainstream services and in particular do not routinely see their GP. These patients will often be seen by a psychiatrist for an annual check and have contact with a healthcare professional as part of the care programme approach. This provides an opportunity for a wider delivery of care which should incorporate advice and steps to achieve smoking cessation.

What are the health risks of smoking?

Smoking is the biggest cause of preventable deaths in England, accounting for more than 80,000 deaths each year. One in two smokers will die from a smoking-related disease.

Smoking increases your risk of developing more than 50 serious health conditions. Some may be fatal and others can cause irreversible long-term damage to your health.

You can become ill:

  • if you smoke
  • through (passive smoking)

Smoking also damages your lungs leading to conditions such as chronic obstructive pulmonary disease (COPD), which incorporates bronchitis and emphysema, and is responsible for 90% of all lung cancers, It also causes cancer in many other parts of the body.

It can damage your heart and blood circulation, increasing your risk of developing conditions such as:

  • coronary heart disease
  • heart attack
  • stroke
  • peripheral vascular disease (damaged blood vessels)
  • cerebrovascular disease (damaged arteries that supply blood to your brain)

Thinking about stopping smoking?

Find out how much you depend on tobacco using the simple addiction test to help choose the best type of support to help you quit.

Accessing the right support

Quitting smoking can be hard, but free services and treatments are available to help and these have been shown to improve the chances of quitting successfully. Smokers are much more likely to quit successfully if they get professional support than if they try to go "cold-turkey".

NHS Smokefree has a range of services on offer to help keep you on track, including:

  • Stop smoking groups
  • One to one counselling, chat to an advisor online
  • Prescription medication to help you control the withdrawal symptoms
  • Access free email and text support programmes
  • Download a free app for smartphones.
  • Find your local stop smoking service

NHS Smokefree helps thousands of people quit smoking every year, talk to your doctor or pharmacistor call :

  •  FREE NHS SMOKING HELPLINE: 0300 123 1044

Medication review

Nicotine is known to stimulate a liver enzyme responsible for metabolising many drugs in the body.

This additional enzyme production causes faster clearance of a number of antipsychotic, antidepressant, and anxiolytic drugs. As a result, smokers may need higher doses of these medications.

In fact, stopping smoking can lead to the doses of some medications needing to be reduced, sometimes by as much as 50% to achieve the right levels.

You should always have your medication reviewed by a health professional before, during and after any quit attempts.

Real Life Experience

I started smoking on my first admission to a psychiatric ward, back in the days when the smoking room was the hub of the ward. I quickly discovered that the only place where there was a sense of camaraderie was amongst the smokers. Smoking gave a framework to the long, distressing days on the ward – it was a reason to leave my room and a chance to connect with people. Cigarettes also provided an easy and available way to self-harm. Smoking felt like a reasonable and sensible thing to do. Twenty-five years down the line, I no longer see it like that.

I have struggled with giving-up smoking and have done so for a while on many occasions, sometimes, even for years. However, as soon as any feelings of distress or situations that caused anxiety came about, the first thing I would reach for was a cigarette, and that remains the case. As a full-time smoker my health really suffered. I used to get frequent chest infections and at one point had emergency treatment due to low oxygen levels. My physical fitness was appalling and I became out of breath really easily. I had yellow fingers from smoking roll-ups and I had yellow teeth to match. I smelt bad and felt bad. I have given up smoking using chewing gum, patches, willpower and medication. The latter gave me the greatest success, and now I only very occasionally have the odd cigarette.

My health improved rapidly when I gave-up and my physical fitness really improved. I felt able to start exercising and began to generally have more interest in looking after my health. One of the main things that giving-up meant for me was being free from craving. Having to always be fulfilling a need was hard and the time before having the next cigarette was always dominated by thoughts of having it. No longer needing to smoke made me feel as though I had more power over my whole life, not just over smoking. Looking back I wish I had never begun smoking, but I do have to acknowledge that it helped me to survive some really hard times, and not to beat myself up about it.