Smoking cessation strategies and treatments

1. Giving up is harder if you have an anxiety disorder.

Yes I can believe that, especially when people are under more pressure to quit precisely at those times when they are being treated for other mental illnesses.

2. Royal College of Physicians recommends prioritising those with mental health problems for smoking cessation treatments.

Well yes, I can see that they want to ensure that mental health patients have the same access to smoking cessation services as everyone else, and that they have worse physical health records in which heavy smoking might play a part. However the requirement to stop smoking at times of crisis imposed as a national strategy creates an agenda that does not necessarily prioritise the patient's mental health: indeed the patient's longevity is a higher priority than helping to resolve the patients' mental and emotional state. Yes it may be a worthwhile goal to live longer, but in the chaos that comes with a mental health disorder, meeting other people's priorities, however well intended, should be less important than addressing the mental health disorder. This might be the right time to give up smoking (probably quite unlikely in most cases), but that should be a decision for the patient and the clinician, not a requirement.

RCP President Dinesh Bhugra talks of wanting to 'improve people's lifestyles and reduce health-risk behaviours, thereby preventing  physical illness and reducing the [financial] burden of mental illness on society'. Shouldn't his first duty be to reduce the burden of mental ill health on those directly afflicted and their families? He really seems to feel that any kind of illness is a result of bad lifestyle choice!

Prioritising people with mental health problems for smoking cessation treatments is perhaps inevitable, especially if they are in hospital, without the freedom of movement required to obtain smoking materials. I work part time in a supermarket and sell tobacco on every shift. Since starting work there in 2004, I've sold about three or four packs of Ni-Quitin. They are not an everyday purchase item, and are accessed more through pharmacies and GPs than shops. If patients are in a psychiatric hospital, and tobacco is unavailable, they may still not be willing recipients of nicotine replacement treatments but if they want any nicotine intake there's no choice. This situation is not tolerable on ethical grounds.

Since we know, from the first link as well as from common sense, that people with anxiety disorders find it harder to stop smoking, why do medics seem to think it's right to require it of patients when they are hospitalised?