Is smoking a mental health issue?

Minnesota is considering increasing the cost of a pack of cigarettes and the reasons make some sense: Cut down on smoking and make a couple of bucks until then.

For many people, the price of a pack of cigarettes is enough to make them quit.

But the Boston Globe presents one of the realities of smoking rarely considered in the effort to stamp it out: The mentally ill smoke as a means of controlling the symptoms of their illness.

“They rely on the cigarettes to soothe their symptoms — what the medications don’t,” April Vargas, who struggles with anxiety and depression tells the paper. The cigarettes help in “handling what they don’t know how to handle.”

People with mental illness may be less able to navigate the health care system to get to the doctors, support groups, or cessation tools that can help them quit. And, despite the significant health risks, many doctors or therapists have seen smoking as a problem that is secondary to managing symptoms of schizophrenia or depression.

Years ago, cigarettes were a pervasive part of mental health treatment, a mode of socializing at group homes and a reward given for good behavior at inpatient facilities.

“I think it’s really important to recognize that some people learned to smoke in hospitals,” said Dr. Ken Duckworth, medical director for the National Alliance on Mental Illness.

While smoking is prohibited today in nearly all mental health facilities, with many banning it even from the grounds outside, Duckworth said that the history of cigarettes in treatment has led some who work in mental health to be less aggressive in urging patients to quit.

It’s probably not mere coincidence, though, that people with mental illness have higher rates of physical illness, too.

In Massachusetts, for example, heart disease killed clients of the Department of Mental Health age 25 to 44 seven times the rate of the rest of the public.

That state is taking action. In addition to its anti-smoking efforts, it’s beginning to change its approach to mental health services to stress nutrition, exercise, and smoking cessation.

In 2000, a study revealed that nearly half of all cigarettes were smoked by someone with a mental health issue during the previous month.

And yet, curiously, it’s not considered a mental health issue in the mainstream.