Professor Chapman's suggestion that I misrepresented his views on the clinical treatment of tobacco addiction, particularly in the case of people with mental illness, may surprise those familiar with his long-standing stance against providing such help [1–5]. Perhaps I chose the wrong paper to cite , rather than the more specific papers in which he argues forcefully for ‘the abandonment of smoking cessation clinics’[4,5], i.e. clinical face-to-face treatments, which he claims ‘purposefully erodes smokers’ confidence in taking control’ and encourages them ‘to do anything but go it alone’. These papers and their arguments overshadow his neutral statement of fact that clinical treatments ‘also help many smokers’.
By arguing for the abandonment of clinical treatments for smokers, Chapman would deny the disproportionately large group of smokers with a mental illness the sort of caring help that respects and considers their comorbidities. Smoking and mental illness was the subject of my original commentary , and I will not reiterate the evidence on the high smoking prevalence rates and tobacco dependence levels among people with mental illness which tell of their past neglect in smoking cessation efforts. However, the UK National Health Service (NHS) now treats about 500 000 smokers annually, suggesting that in the region of 250 000 with a history of mental illness and 125 000 with a current mental illness are cared for [6,7]. These lives are not a drop in the ocean.
If Professor Chapman now believes that clinical treatment for tobacco dependence should be a major plank in any tobacco control strategy and supports offering people with mental illness help to stop smoking, I would be delighted to hear this.
I ask those opposed to clinical treatment: if you had a loved one with a mental illness who had failed to stop after ‘going it alone’ for many years, wouldn't you now want them to get the most effective care? How then would you feel if they approached a general practitioner or specialist only to be told, ‘yes, I can increase your chance of stopping with a very cost-effective method, but remember: failures are a normal part of cessation; the majority find it unexpectedly easy to quit; and cold turkey is the method most commonly used. So go away and get on with it’.