“It’s the one thing they have left”: smoking, smoking cessation and mental health

People with mental disorders are twice as likely to smoke compared with the general population and are more likely to die from tobacco-related disease. There are unique factors that contribute to the elevated smoking rate in this group and that act as barriers to cessation, including higher nicotine-dependence levels, reduced receipt of cessation support, perceived negative impacts on mental health functioning, and social and cultural influences. Despite this, a number of effective smoking-cessation treatments are available, including pharmacological support such as NRT, varenicline and bupropion, and psychological strategies such as behavioural support and CBT. Evidence suggests that smokers with a mental disorder are able and willing to quit, but long-term cessation rates are low. Improving routine delivery of nicotine-dependence treatment within mental health treatment settings may prove to be an effective method for achieving sustained smoking cessation in this group, given the strong interconnectedness between smoking and mental health treatment.