Academic journal article Australian Health Review

Two Heads Are Better Than One: Australian Tobacco Control Experts' and Mental Health Change Champions' Consensus on Addressing the Problem of High Smoking Rates among People with Mental Illness

Academic journal article Australian Health Review

Two Heads Are Better Than One: Australian Tobacco Control Experts' and Mental Health Change Champions' Consensus on Addressing the Problem of High Smoking Rates among People with Mental Illness

Article excerpt

Introduction

In Australia, people with a more prevalent mental illness (depression andanxiety)aretwice aslikely to smokeas those without a history of mental health issues.1 - 3 Australian data for 2010 show that 32% of smokers report a mental illness,4 compared with a national daily smoking rate of 15.1% for the whole population.5 Among people with low-prevalence mentalillness (e.g.psychotic conditions like schizophrenia, or severe depression or bipolar disorder), smoking rates are even higher and have barely changed in the past 12 years.6 Of Australians with a psychotic illness, 68.9% were smokers in 1997-98 and 67.2% smoked in 2010,6 compared with smoking rates of 26% in 1998 and 20% in 2010 in people with no history of mental illness.7

In Australia, smoking accounts for 12% of the disease burden, with A$31 billion in social costs per annum,8 These costs are even greater for people with mental illness. Smoking-related illness remains the main contributor to a 25-year reduced life expectancy for people with mental illness compared with the general population.9,10 Population-wide cessation measures have not produced a decline in smoking among people with mental illness in Australia, nor has any clear direction emerged from targeted measures. Smoking has been 'taken for granted' in mental health care for decades, with a limited response to this problem despite evidence that people with mental illness want to quit and can quit when encouraged and supported.11-13 In Australia, people with mental illness on government-provided benefits and pensions are able to obtain nicotine-replacement therapy and other smoking cessation aides [Champix (Varenicline; Pfizer, Sydney, NSW, Australia) and Zyban (Buproprion; GlaxoSmithKline, Boronia, Victoria, Australia)] by prescription from their general practitioner at substantially reduced costs.14 Although there have been promising results for cessation from intensive community-based mental health smoking cessation programs, these measures have not been widely implemented.15,16

There are three main knowledge gaps regarding options for action for reducing smoking among people with mental illness. First, there are uncertainties about why people with mental illness are more likely to become smokers.1 Second, it is not known how to systematically integrate smoke-free policies and health promotion strategies throughout the mental health system for best advantage.1 Third, it remains unclear how smoking cessation support can be improved to increase success rates in this population from a broad public health policy, health systems and community perpective.1 The present study was undertaken to help address the third knowledge gap, by asking Australian tobacco control experts and change champions within the mental health sector to develop recommendations for overall structural changes that may achieve improvements in smoking cessation for people with mental illness.

Proposed explanations for why people with mental illness are more likely to become smokers are drawn from a range of perspectives, the differences of which may have led to a siloed andlargely unsuccessfulresponse totheissue. The environmental perspective considers that the tobacco industry has specifically targeted psychologically vulnerable people;16,17 the sociological perspective draws a strong association between low socioeconomic status and mental illness, with socioeconomic status being a risk factor for the uptake and continued use of tobacco.1,14 A sociohistorical perspective argues that the cause is the prosmoking culture and environment in mental health services.18-21 Themedical (biological and psychological)perspective considers tobacco is used to self-medicate psychological distress,22,23 may be an antecedent to depression or anxiety24,25 or, conversely, that mental illness plays a role in causing smoking because of a common genetic predisposition.26,27 The combined biopsychosocial perspective considers causation to be a combination of genetic and environmental predispositions contributing to both smoking and mental illness. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.