Mark Rowland gave evidence.

We will now hear from Mark Rowland, chief executive of the Mental Health Foundation. We have until 3 pm for this panel. Would the witness please introduce himself for the record?

Mark Rowland:

Thank you, Chair, and I thank the Committee very much for inviting me. I am really happy to be here. My name is Mark Rowland and I am the chief executive of the Mental Health Foundation, which has been around for just about 75 years—not quite as old as the NHS. I am also the co-chair of the Mental Health and Smoking Partnership, which brings together 25 or so academic institutions and charities to look at the relationship between smoking and mental health, and is organised by ASH.

Q In popular culture, there is this pervasive myth that smoking relieves stress and anxiety, when we all know that it does not. We know how damaging thinking like that has been. There was a school in my constituency that decided to give a young person a leaflet about how to address anxiety, which I was quite dismayed to see said, “smoke a cigarette”. Do you think that this Bill addresses those concerns?

Mark Rowland:

I was saying earlier on that this myth about smoking appeasing the symptoms of anxiety and stress does not come about by accident. It has been purported by the tobacco industry. The tobacco industry has deliberately commissioned research into the proposed impacts of smoking, looking for some sort of consequence for relieving long-term stress. You are absolutely right that it is not just a myth, but a pernicious myth, because it does exactly the opposite. The only thing that smoking does is relieve the immediate symptoms of nicotine withdrawal, deepening the addiction. We know now that it exacerbates the symptoms of poor mental health across the population, particularly for common mental health disorders, as well as serious mental illness. We now see that there is a causal relationship between smoking and mental health.

You asked whether the Bill does enough; the Bill does not directly address the myth. I am very grateful that this Committee has called me to specifically talk about the relationship between smoking and mental health, because it is often not in the public conversation. I feel really strongly that there is a generation who have been let down and deceived, and that has unfortunately seeped into the practice and perception of mental health professionals over the years as well. In 2008, which was the first time that smoke-free policies were made mandatory in mental health settings, we looked at the attitudes of mental health professionals compared with other medical professionals. We found that one in three had serious reservations about introducing smoke-free policies into mental health settings, versus one in 10 for other medical professions.

It has let down people who have then become addicted and experienced the poor mental health and physical health consequences. This Bill will make an important contribution. I think there is an amendment to put an insert into cigarette packages that directly takes on that myth. Given the long history of deception and misinformation, we would strongly take the opportunity to support that amendment to this Bill, so that future generations can be in no doubt that it has no mental health benefits whatsoever.

Q Thank you. It is an amendment that I tabled based on the concerns raised by young people in a school near me. There is a generation of children who are addicted to nicotine, because there have been clear loopholes on marketing and giving free vapes. Do you think that there is enough support within communities to help children who are addicted to quit? Does that actually exist for young people?

Mark Rowland:

For nicotine or smoking?

Q Nicotine, whether by smoking or vapes.

Mark Rowland:

The commitments that were made in relation to the long-term NHS plan—the five-year forward view for mental health—were really important, but our NHS colleagues say that they are not well-funded. We are roughly £10 million to £20 million short of completing the opt-in in mental health settings. It is currently an opt-out, and that has been hugely successful. About nine in 10 inpatient services are now adopting the smoking cessation offer, but you are right to say that it has not extended anywhere near far enough in terms of community settings.

Community mental health services, for example, have only had a pilot for smoking cessation. It is on an opt-out as well, but there are only seven pilot sites. It is relatively cheap; £10 million to £20 million could expand community smoking cessation to mental health services and integrate it within that. That would be a really smart thing to do.

We can also see that most people who experience distress, depression or anxiety will go through talking therapies. There is a really big opportunity there—my wife is a therapist—but there is no standard mechanism for therapists to check smoking status as they are coming forward to help. One of the things on which we have really accrued evidence, through Cochrane and systematic reviews, is the mental health benefits of stopping smoking. We think there is much more that could be done at those access points, such as talking therapies. Why not think about a holistic approach to stopping smoking alongside the psychological talking therapies assistance that is being offered to about 1.6 million people? There is more to do.

In relation to young people, I think that could be added to that component in child and adolescent mental health services as well to understanding. Let us have a whole picture of what our young people are facing, because we know that the causes of mental ill health are often multi-varied, so we need to understand what the causes are and also what the coping mechanisms are. One of the reasons we are so passionate about this Bill is that what smoking does is provide an out for young people and adults to be able to really look at the emotional distress that they are experiencing and manage those difficult emotions in a healthy, life-affirming way, so there is much more to do.

Q Thank you so much for being here this afternoon. It is incredibly helpful. Can I ask you the chicken-and-egg question? Does smoking make you depressed, does depression cause you to smoke or is it both? I think you are possibly saying both.

Mark Rowland:

I think five or 10 years ago we would probably have said that it is more likely that, if you are depressed or anxious, you will reach for a cigarette to appease the emotional distress in the short term. The work from academics at the University of Bristol has found that there are now good population studies looking at the impact of smoking leading to a first instance of mental health problems and the fact that there is a causal relationship between smoking and mental health. We are already facing, as this Committee will be aware, a mental health crisis in this country, and 23% of the health burden is a result of mental ill health—one in four in any year, one in six in any week. The efforts to reduce smoking will, we think, have both an impact in reducing prevalence and in reducing acuity of mental ill health.

On the chicken and the egg, it is difficult to disaggregate exactly for many people, but we know that both are a real issue. We talk about this cycle of smoking increasing the risk of poor mental health and poor mental health increasing the chances of smoking and the number of cigarettes someone smokes. People with mental health problems smoke far more, and that addiction then exacerbates psychiatric symptoms. Those psychiatric symptoms also then lead to increased poverty and increased chances of being unemployed, and that leads to poorer mental health. It is a complex picture, but we are really starting to see the causal drivers of mental ill health.

I will finish by saying that this Government should be applauded for introducing this progressive, bold and far-sighted piece of legislation. We have called for a long time for a cross-Government approach to mental health, and we would have been calling for exactly this type of legislation in that approach to give young people—give us all—a fighting chance for better mental health, so that we can reap all those benefits.

Q We have seen that the number of 11 to 17-year-olds vaping has trebled in the last three years, which is terrifying. We have also seen the mental health of young people fall off a cliff. A lot of people would argue that that is to do with social media and the act of scrolling and what that does to the brain and so on, but would you say that smoking is another factor that should be taken into the mix of what is happening to young people’s mental health, or would you say that it is not proven yet?

Mark Rowland:

Are you asking whether increased smoking and vaping is a driver of young people’s mental ill health?

Very specifically the increase in children vaping, which is nicotine as well. It is the same addiction.

Mark Rowland:

The causes of the deterioration of young people’s mental health are really complex. There are a number of different factors, and it is difficult to disaggregate them all. There is social media and what we call the social evaluative threat, which emerges from being in a context where you are able to see how you are doing in life against everyone else in the world. It is the first time we have had that in human history, so no doubt we need greater protections in the use of social media for young people.

In terms of the evidence of vaping and young people’s mental health, we have not seen a causal relationship between vaping and poorer mental health. We know that all addiction is bad for all of us, especially young people. We did a Delphi study a couple of years ago looking at the most important protective factors for people’s mental health, and No. 1 was, “Don’t become addicted to drugs.” That had the most deleterious impact. It is not going to help if more young people are addicted to nicotine, for absolute sure. It comes back to the original point that we need to equip our young people with skills to be able to manage difficult emotions and not look for the quick dopamine hit that nicotine provides. So it is not helping, but is it the major driver of children’s mental ill health? We do not have the evidence to be able to point to that right now.

Q I am interested in the exchange that has just taken place. You have said that all addiction is bad for us, which makes sense to me. We heard evidence yesterday about the impact of young people vaping in schools. Some of that impact is the disruption to education and the challenge for young people if they a need to go out of the classroom to vape because the pull of the addiction is so strong. I wonder what your thoughts are on the mental health impact of the addiction in the education setting. I would also welcome your thoughts on the connections with sports; I am particularly interested in sports organisations advertising vapes, which I think is a poor choice. I think sport should have a positive impact on the mental health of young people, but I am not sure that connects properly when these vapes are being advertised.

Mark Rowland:

I really support the Bill’s efforts to regulate and protect young people from ever engaging in vaping. As you say, it is about the unintended consequences. We are not quite clear on the mental health consequences of vaping for young people. We know that young people who have lower levels of mental wellbeing are more likely to vape. We know that the targeting of young people drives them into addictive behaviour, so we need to protect young people from that. We need a regulatory environment that does not allow young people to be exposed to advertising that is particularly targeted at them. I would support such a measure.

I think the unintended consequence of children missing out on education due to vaping cannot be underestimated. We also have an issue around the mental health of young people who are not attending school—the school rejectors. We need to bring them into an education environment in which we can see what that young person needs and what the consequences for their mental health have been from not being in school. I would rather kids were in school and that that educational setting was protected for them.

When I worked in mental health servicesQ , we often found that there was an association between people who were smoking cigarettes and also cannabis and having aggravated psychotic symptoms. Do you think that the measures in the Bill will help people to avoid smoking in general and therefore be less likely to move on to smoking cannabis as well and aggravating those psychotic episodes?

Mark Rowland:

The evidence around cannabis use and the increased risk around psychosis is really clear and strong. I have personal experience of the absolutely devastating experience of friends who have experimented casually with cannabis and the consequences for their mental health.

It is a fair supposition to make for you as legislators that a Bill that makes such a symbolic and strong stand against young people getting addicted to smoking, reducing the rates and preventing young people from getting addicted to vaping will set a fantastic context for preventing addiction to other substances. Would it not be great if we also saw some delay in the first experience of young people drinking? We could be on the cusp of doing something really fantastic for young people if we look at the range of addictive or self-soothing products, and cannabis would be one of them. If you break the chain and teach people how to manage their mental health and distress in a positive way, you will reduce the risk of people choosing addictive and damaging products to do that for them.

If there are no further questions, can I thank the witness? We will move on to the next panel.