Smoking and mental health - NCSCT

Smoking and mental health
cessation pharmacotherapy and behavioural support through NHS stop
smoking services.
The mental health strategy ‘No health without mental health’ 118 highlights a
twin track approach involving early intervention for mental disorders, and
promotion of wider population mental health. Acute mental health services have
an important role to play in preventing homelessness by ensuring that people are
not discharged from hospital with nowhere to go. 118 Coordinated smoking
cessation provision, including relapse prevention, between primary and
secondary care services is important to promote long-term cessation and early
intervention if relapse occurs.
7.4.7 Summary points
> Homelessness is associated with high rates of smoking and mental disorders,
which contribute to significantly reduced life expectancy.
> Homeless people who smoke are generally aware of the risks of smoking and
the benefits of quitting.
> Smoking cessation interventions are effective in this group, although, as is
generally the case among heavily dependent smokers, success rates are
relatively low. More intensive levels of support and high-dose NRT may be
particularly important in this group.
> To promote and support smoking cessation, it is also important to challenge
the acceptance of smoking as a normal behaviour in homeless culture.
> Staff working with homeless people need appropriate training to support
smoking cessation and maintain smoke-free environments, in caring for the
homeless.
7.5 Smoking, mental disorders and pregnancy
7.5.1 Smoking in pregnancy
Smoking is one of the main causes of birth complications, low birthweight,
preterm birth and perinatal deaths, including stillbirths and sudden infant death
syndrome (SIDS). 119,120 Adverse health impacts for the fetus exposed in utero
are also known to extend into childhood, 120 and recent studies suggest that this
may also apply to childhood conduct/externalising problems 121,122 and
obesity. 122,123
Women who smoke are more likely to stop smoking during pregnancy than at
other times in their lives, 124 and up to 40% do so before their first antenatal
visit. 125 However, cessation is much less likely among those who are still smoking
when they begin antenatal care, 126 and in England in 2011 over 13% of women
smoked throughout pregnancy. 127 Smoking through pregnancy is strongly
146 © Royal College of Physicians 2013