A report out yesterday on the prevalence and costs of smoking among people with mental illness has been getting lots of play. The Access Economics report commissioned by SANE Australia claims “Based on the Australian Bureau of Statistics (ABS) data, 31.8% of adults with a mental illness are daily smokers compared to 17.7% of adults without mental illness, and over one quarter of Australians (25.7%) have some form of mental illness.”

Something has to be seriously wrong here. The latest (2004) ABS National Health Survey data shows that 18.6% of Australians aged 14 and over (with or without mental illness) smoked daily. More recent NSW data show the figure in that state fell to 13.9% in 2006. So if we are to believe that more than one in four Australian adults have “some form of mental illness” and were thus not counted in Access’s 17.7% figure, then how can these figures possibly be reconciled?

Access puts the cost of smoking by the mentally ill at $33 billion for 2005. Economists David Collins and Helen Lapsley, who have calculated the economic costs and benefits of smoking for the Commonwealth Health Department, put the total costs of smoking (not just those run up by the mentally ill) at $21 billion for 1998-99.

So are one in four of us, in fact, burdened with “some form” of mental illness? Or might there be a touch of talking up the numbers here for a lobby group client eager to get the ear of the new government with a dramatic sound bite? A major review by Drs Mark Ragg and Tanya Ahmed recently commissioned by the Cancer Council NSW noted that “the prevalence of mental illness in Australia is either 11% or 18%, depending on the survey tool used.” In 2004-05, “11% of all persons reported they currently have a long-term mental or behavioural problem. In the 1997 National Survey of Mental Health and Wellbeing of Adults, which is based on diagnostic criteria rather than self report, almost one in five adults (18%) had a mental disorder at some time during the twelve months prior to the survey.” Has the prevalence of mental illness really increased 42% from 18% to 25.7% in 8 years?

So Access Economics’ figure of 25.7% “having” some form of mental illness is either 136% higher than the figure obtained by people rating their current mental health or 42% higher than estimates made by trained interviewers, of the incidence of symptoms at any time during a 12 month period. Most of these 18% are people with anxiety and mood disorders, and drug and alcohol use disorders. A few days of morbid desolation or a bender following a separation or the sack followed by 11 and a half months of feeling fine could get you a mental disorder rating if you were swept up in the sample.

Ragg and Ahmed conclude that “Commonly quoted statistics – that 80% to 90% of all people with schizophrenia smoke and that 44% of all cigarettes are smoked by people with mental illness – are false. They are an exaggeration brought about by unreasonable extrapolations from specific research.” They talk about the way that reports providing large estimates of mental illness in communities attract lots more attention and research citation than those providing more conservative estimates. A bigger number is more memorable than a smaller one.

Economic consultancies are engaged by health lobby groups to talk the talk to mandarins. When is the last time we read about a health problem where the problem was concluded to be less prevalent or serious than the last time it was considered?

Peter Fray

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