Smoking

Why it matters  

Smoking is the biggest cause of preventable death, illness and disability in England. 

Two in three people who smoke will die because of their tobacco use. People who smoke are almost twice as likely to need some form of social care in later life than people who have never smoked. 

- National Centre for Smoking Cessation and Training, 2024.

Smoking is a cause of poor mental health across the whole population. Smoking and mental ill health create a ‘cycle of dependence’. Smoking increases the risk of developing some mental health conditions. Smokers with poor mental health are often more heavily addicted to smoking and are less likely to successfully quit. This then leads to physical health problems. 

People are less likely to be employed; and makes them financially poorer. These factors then cause a further decrease in mental health. (Action on Smoking and Health & Royal College of Psychiatrists, 2022).  

Smoking rates are particularly high among people:

• With mental illness.
• Experiencing homelessness.
• In the judicial system.
• In alcohol and drug treatment.
• With routine and manual occupations.
• Living in social housing.

People with a serious mental health condition are more than twice as likely to smoke than the general population. For example, schizophrenia, and psychosis. The life expectancy of people with a serious mental health condition is 10-20 years less than the general population. This is largely due to smoking. Over a million people in the UK have a more common mental illness (e.g. anxiety, depression) and smoke. (Action on Smoking and Health & Royal College of Psychiatrists, 2022). However, people with a mental illness are just as likely to want to quit smoking as those without. (National Centre for Smoking Cessation and Training, 2024).

Quitting smoking may be tougher at first for those with a mental health condition. But it leads to improved mental wellbeing and helps ease anxiety and depression. The impact of stopping smoking can be the same as taking antidepressants. (National Centre for Smoking Cessation and Training, 2024).

Local Stop Smoking Services (LSSS) are a key investment in addressing tobacco use and tackling inequalities in smoking. People who quit using LSSS are at least three times more likely to still not be smoking after one year. This is compared to those without any form of support. (National Centre for Smoking Cessation and Training, 2024). 

What’s happening in Calderdale

Currently South West Yorkshire Partnership NHS Foundation Trust (SWYPFT) is commissioned to provide the Local Stop Smoking Service. The Yorkshire Smokefree Calderdale service includes:

• Very Brief Advice on smoking training for front line workers using the Ask, Advise and Act model
• Level 2 service delivered by some local GPs, pharmacies, and other partner organisations.
• Level 3 specialist stopping smoking service, including 1-1, group, telephone and online support.
• Provision of free stop smoking products including Nicotine Replacement Therapy (NRT), e-cigarettes and licensed stop smoking medications.

SWYPFT also provides mental health care in hospital and community settings. This means that there are close links between the stop smoking service and mental health services in Calderdale.

As part of the NHS Long Term Plan, NHS tobacco dependency services have been funded within:

• Acute hospital wards.
• Maternity services.
• Inpatient mental health settings. 

Anyone admitted to one of these health services is offered support to quit smoking if they wish. They are then referred on to the local community stop smoking service when they are discharged. 

Every local authority in England has been awarded additional grant funding. This must be used to enhance local stop smoking services and support over a five-year period (2024-2029). The amount of funding allocated each year will depend on the number of smokers in each local authority area. Calderdale Council has agreed that the funding awarded to Calderdale will be used to:

• Identify people who have an existing health condition who smoke and offer support to quit.
• Address inequalities in smoking. Make our local stop smoking services and support more accessible to the population groups with the highest smoking rates.
• Support more people to quit smoking in pregnancy and remain quit after delivering their baby.

What the data tells us

Smoking prevalence in Calderdale is about 9.1% which is below Yorkshire & Humber (12.7%) and England (11.6%) rates. Smoking prevalence is higher in certain groups including:

• people aged 18-64 years working in routine or manual occupations (10.9% in Calderdale)
• adults with long term mental health conditions (24.2% in Calderdale)
• adults in treatment for alcohol and/or non-opiate drug use (66.7% in Calderdale)

Estimated smoking rates across the five neighbourhoods in Calderdale were analysed. They show a significantly higher smoking rate in those aged 15 years and over in North Halifax. This is compared to the Calderdale average. More information on the health of the five neighbourhoods can be found on Data Works.47 

8.1% of pregnant women are recorded as being a smoker at the time of delivering their baby. This is lower than the Yorkshire & Humber average of 9.3% but higher than the England average of 7.4%.

A greater proportion of adult smokers set a quit date with the Calderdale Stop Smoking Service. They also successfully quit after 4 weeks support. This is compared to the averages for Yorkshire & Humber and England. More information is available here: Smoking Profile - Department of Health and Social Care.

Smoking, Mental Health, and Suicide Risk: A Research Overview 

There is some evidence that smoking is associated with an increased risk of suicide, particularly in females. Men who currently smoke are twice as likely to die by suicide than men who have never smoked. Women who currently smoke are 2 ½ times as likely to die by suicide than women who have never smoked. (Echeverria et al 2021). There is also evidence that smoking increases the risk of experiencing suicidal thoughts.

Some of the risk factors for suicide are also risk factors for being a smoker, such as:

• having a low income or being unemployed
• experiencing mental health conditions like psychosis, anxiety or depression
• using substances like alcohol or drugs
• having a physical illness

This might help to explain why there is a link between smoking and risk of suicide. Scientists have also proposed that the link may be due to the nicotine in cigarettes acting on the brain. This may cause someone to be more impulsive. Another theory is that smoking increases the likelihood of someone having a physical illness. This then in turn increases the risk of suicide or suicidal thoughts.

Smoking rates are significantly higher in people with a mental health condition than in those without. This leads to poorer long term health outcomes and a reduced life expectancy. There is some research evidence that smoking can cause some mental health conditions to develop. These can include depression and schizophrenia. (Wootton et al 2022 - Is there a causal effect of smoking on mental health: A summary of the evidence. Produced by MRC Integrative Epidemiology Unit, University of Bristol, on behalf of Action on Smoking and Health). There is strong evidence that smoking can make mental health conditions worse. 

Despite this evidence, people with poor mental health often say that smoking helps them cope with their symptoms. It is common for people to say that smoking helps to relieve anxiety or lift their mood. This contributes to the reason why more people with a mental health condition continue to smoke than the general population.

When someone stops smoking, they may experience some short-term mental health effects. These are due to the withdrawal from nicotine and can include:

• Anxiety.
• Irritability.
• Low mood.

However, there is strong evidence that stopping smoking improves mental wellbeing in the long term. This is both in people with a diagnosed mental health condition and in people without. (Taylor et al 2021). There is no evidence that stopping smoking will cause any mental health symptoms to become worse.

First choice stop smoking products have been shown to be effective for people with a mental illness. These include:

• Nicotine Replacement Therapy (NRT).
• E-cigarettes.
• Some licensed medications. 

People with a mental illness are often more heavily addicted to smoking. Therefore, they may need more tailored and flexible support to quit. For example:

• Higher strength NRT
• Use of stop smoking products for a longer period
• Flexible appointments and 1-2-1 behavioural support
• A ‘cut down to quit’ approach rather than quitting abruptly

(National Centre for Smoking Cessation and Training, 2024)

Research shows the complex relationship between smoking, mental health, and suicide risk. It highlights the need for targeted interventions to address smoking in people with poor mental health.

What this means for working age adults in Calderdale

Strengths

• Smoking rates are lower in Calderdale than the average rates in Yorkshire & Humber and England.
• Calderdale’s Stop Smoking Service is reaching a greater proportion of smokers than services in other parts of the country. Quit rates among people accessing the service are higher than average.
• Stop smoking support and mental health care are delivered within the same organisations in Calderdale (SWYPFT and GP practices). This enables close working between services.
• The government has allocated additional grant funding to enhance our local support offer and test new approaches in 2025/26.  We expect this to continue each year until 2029. 

Needs

• Reduce health inequalities. Embed additional stop smoking support in teams already working with population groups with higher rates of smoking. This could include people with a mental health condition and people in treatment for alcohol and/or drug use.
• Review the local stop smoking support offer to better meet the needs of:
  • People with a mental health condition E.g. introduce a ‘cut down to quit’ approach; provide support for a longer period.
  • People from groups e.g. neurodiversity or LGBTQ+ who can be at higher risk of suicide.
• Increase the understanding of the public and of health professionals about the link between smoking and mental health.