Quality of Life

The following is an email exchange about smoking and people who experience mental health conditions. The final section was written by MHA's Compeer Coordinator, Kristen Frame.

A daughter who grew up with a mentally ill parent:

I have understood for some time that tobacco helps reduce the  incidences and frequency of hallucinations and delusion of a person suffering from debilitating mental illnesses like schizophrenia.  If is does, then quality of life should be in the equation.   There is no cure for many of our mental illness, only control of symptoms.  I  ask, if you had to choose, which would you pick.

I do not at all advocate tobacco use, but  I feel for the mentally ill patient, there should be  some exception to the general rule here. 

My understanding is that it is nicotine, rather than tobacco, that positively impacts some schizophrenia symptoms and drug side effects. Does someone in the group have some other information about positive effects from tobacco smoke or other tobacco components for patients struggling with psychosis, etc.? Certainly the negative health effects of tobacco smoke causes other immediate mental and physical issues for people with chronic mental conditions, so eliminating tobacco smoke would be helpful. 

A suggestion is to reach out to the facility to do training for their staff about smoking and mental illness, harm reduction, and how to support patients in reducing or eliminating smoking.  An intermediate step for these particular patients would be to use NRT - lozenge or gum - with these patients rather than chewing tobacco which can lead to oral cancers. And then work with them on use reduction of the NRT.

As you have said, the “positive” effects of tobacco usage are not a justification for not counseling individuals who experience persistent mental illness about the overwhelming evidence that tobacco usage is a significant health hazard and the leading cause of death for individuals with persistent mental illness. There is a short term alleviation of symptoms but like the elusive high of other drugs, it is very short-term and does decrease over time.

This mythology has been perpetuated by outdated “studies” that were funded by the tobacco industry, and debunked by recent more scrupulous current research. A significant portion of individuals who experience mental illness are addicted to tobacco and remain untreated because it is economically advantageous to keep them that way.

Diane writes: “I have understood for some time that tobacco helps reduce the incidences and frequency of hallucinations and delusion of a person suffering from debilitating mental illnesses like schizophrenia.  If is does, then quality of life should be in the equation.   There is no cure for many of our mental illness, only control of symptoms.  I ask, if you had to choose, which would you pick.”

There may currently be no “cure,” but there is recovery and the opportunity for a fully enriched life on one’s own terms. Quality of life is the most important aspect of the equation. Informed decision making is not possible for those who are given inaccurate or misleading information about tobacco addiction. As an advocate, and individual who experiences persistent mental illness, I pick independence and a life constructed of my own informed choices, not reduced to passively accepting a significantly shortened and physically and economically dependent life. We do not accept the notion that alcoholics or other addicts should be supported in the state of addiction because, poor souls, their life is so terrible, we will permit them this vice. Not giving individuals who experience mental illness the up-to-date and appropriate medical treatment that we expect for their peers is not only disabling, it is criminal. Individuals with disabilities do not need to be treated as exceptions, but as equal human beings.

I appreciate your genuine empathy and concern for individuals who experience mental illness. We need equal treatment under the law, not sympathy.

Stop Smoking.... Stop It!

I was recently shocked to learn that a friend has taken up smoking, so that she can feel more confident in social situations. This is a very intelligent woman who is otherwise health conscious. She watches her weight, walks for her health and regularly visits her doctor. She had successfully quit smoking years ago, and has now taken it up again.

She is also a person who experiences mental illness, and it is my great fear that she will become another statistic-one of the thousands of individuals who experience mental illness and are addicted to nicotine.

As a non-smoker, I find it hard to conceive of why, in 2009, with all the facts we know about the dangers of smoking, anyone would start to smoke. The facts about individuals with mental illness who use nicotine are particularly ugly:

About 200,000 of the 435,000 annual deaths from smoking in the U.S. occur among patients with mental illnesses and/or substance use disorders.

About 20% of the U.S. population has mental disorders in a given year. Over 40% of these individuals use tobacco.

Americans with mental illnesses represent an estimated 44.3% of the U.S. tobacco market.

Americans with mental illnesses and substance abuse disorders are nicotine dependent at rates that are two to three times higher than the general population.

Because people with mental illnesses use tobacco at greater rates, they suffer greater smoking-related medical illnesses and mortality.

Why do individuals who experience mental illness smoke more?
Researchers believe that a combination of biological, psychological and social factors contributed to increased tobacco use among persons with mental illness.

Persons with mental illnesses have unique neurobiological features that may increase their tendency to use nicotine, make it more difficult to quit and complicate withdrawal symptoms.

In addition, providers often think that people with mental illness are unable to quit smoking, which is not true. Studies show that people with mental illnesses want to quit smoking and want information about cessation services and resources. Significant evidence shows that smoking cessation strategies work. People with mental illness can successful quit.

Symptom management often takes precedence over preventative health measures. There are clinicians who do not perceive nicotine cessation as a treatment priority, or consider it as too consuming of limited treatment resources.

Historically, patients in psychiatric units were even given cigarettes as a method of reward and control and patients were told that cigarettes could be helpful in their treatment. According to a report by the University of Colorado-Denver, Department of Psychiatry, in the late seventies and early eighties, tobacco companies distributed free cigarettes to homeless shelters, mental hospitals and homeless service organizations. Cigarettes were purchased for persons experiencing mental illness and homelessness, so that these individuals would smoke “clean” cigarettes, not used “butts.”

The tobacco industry also targeted psychiatric hospitals for sales promotions and giveaways.

We talk about the shackles that were used in mental hospitals in the past and the lasting effects of their usage on the national psyche. What of the effects of the knowledge that patients were given cigarettes and encouraged to smoke, when their doctors knew the dangers of tobacco and chose to overlook those dangers in favor of control and submission of patients?

I recently heard a counselor say that he was opposed to a ban on smoking in his consumer-care facility because that is how he builds trust with his consumers-by smoking with them! Imagine if he had said that he built trust through drinking together.

With funding cuts, it is becoming more difficult to find resources for smoking cessation programs. Thousands of individuals who experience mental illness are currently addicted to nicotine and are struggling to find an answer to ending their dependency.

Statistics for this blog was taken from “Smoking Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health Providers”

--Kristen Frame
Compeer Coordinator