Exprt Commentary Sandy ASH Scotland专家评论砂质灰苏格兰.docVIP

Expert commentary to accompany: ASH Scotland case studies of stop-smoking support in mental healthcare settings Action on Smoking and Health (Scotland) (ASH Scotland) is a registered Scottish charity (SC010412) and a company limited by guarantee (Scottish company no 141711) Expert Commentary #1: Colin Colin’s mental health condition, schizophrenia, is associated with very high smoking rates. Research suggests that around 88% of people living with schizophrenia smoke(1), with 68% classed as heavy smokers (25 or more cigarettes daily)(2). It has been suggested that one reason for this high prevalence is that smoking can alleviate some of the symptoms of schizophrenia. While there is some evidence for this ‘Medication Hypothesis’, overall the research suggests that these alleviating effects occur in only a minority of individuals and are very short lived(3). Indeed, more robust evidence exists to suggest a damaging effect of smoking on mental health (see the case study of Sandy (#2) for more on this). It is notable that Colin started smoking after being admitted to a psychiatric in-patient unit, a phenomenon which is fairly common. Colin’s own explanation of why this happened serves to highlight two other important theories (aside from the ‘medication hypothesis’) of why smoking rates in mental healthcare settings are so high. The first is the ‘Cultural Hypothesis’ and relates to how smoking is central to the culture of mental healthcare settings (see the case studies of Sandy (#2) and Julie (#6) for a more detailed discussion). The second is the ‘Void Hypothesis’, which is related to the view that mental health service users smoke out of boredom and because ‘they have nothing else’. Put simply, without smoking there would be a large ‘void’ in patients’ lives. While there may be some validity in this assumption, it is worth noting that this theory may exist to some extent as a ‘self-fulfilling prophecy’ generated by healthcare staff and even family o