Mental health is fundamental to the wellbeing of individuals, their families and the population as a whole (ABS 2018). According to the 2019 National Drug Strategy Household Survey (NDSHS) estimates, 16.9% of the general population aged 14 and over had been diagnosed or treated for a mental health condition in the previous 12 months. This increased from 15.9% in 2016 (AIHW 2020). The proportion of people aged 18 and over experiencing high or very high levels of psychological distress also increased, from 11.7% in 2016 to 14.0% in 2019 (AIHW 2020).
Increasing literacy and awareness around mental illness in Australia may partially explain these reported increases (National Mental Health Commission of NSW 2015), however, there are likely to be other factors involved including changing trends and patterns in alcohol and other drugs use.
There is a complex relationship between mental health and alcohol and other drug use. A mental illness may make a person more likely to use drugs to provide short-term relief from their symptoms, while other people have drug problems that may trigger the first symptoms of mental illness (AIHW 2020). It is often difficult to determine whether mental illness preceded substance use or vice versa. In particular, self-reported survey data (such as that reported in the NDSHS) do not establish a causal link between mental health conditions and drug use (AIHW 2020).
Tobacco smoking has declined among people with mental health conditions or high or very high psychological distress, but remains higher among these groups than people without mental health conditions (AIHW 2020). According to 2019 NDSHS estimates:
- between 2016 and 2019, there were significant decreases in the proportion of people who smoked daily among those with mental health conditions (from 24% to 20%) or high or very high levels of psychological distress (from 24% to 21%)
- the proportion of people with high or very high psychological distress who had never smoked increased, from 50% in 2016 to 54% in 2019
- however, in 2019, people with mental health conditions were still twice as likely to smoke daily as people who had not been diagnosed or treated for mental health conditions (20% compared with 9.9%)
- people who reported high or very high levels of psychological distress were also twice as likely to report daily smoking as those who reported low psychological distress (21% compared with 9.5%) (Table 2.72; Figure MENTALHEALTH1).
The mechanisms linking tobacco smoking with mental health conditions are complex; however it is understood that people may perceive smoking to be helpful in relieving or managing the psychiatric symptoms associated with their disorder (Minichino et al. 2013). It has also been shown that people with mental health conditions may find smoking cessation difficult. However, upon quitting, they are likely to experience improvements in their mood, general wellbeing, mental health and quality of life (Greenhalgh, Stillman & Ford 2018).