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Nearly 1 in 5 adults in the U.S.—about 45.7 million Americans—have some form of mental illness and we now know from a recent report from the Centers for Disease Control and Prevention that adults with some form of mental illness have a smoking rate 70 percent higher than smokers facing no mental illness.

This is a subject that is not often touched upon publicly, as mental health issues can get overlooked or stigmatized by media. Nonetheless, it is a heartbreaking reality that individuals with serious mental illness die 25 years earlier than the general population – pointing out the glaring need to address tobacco addiction within the community as one way to help decrease this gap. But if we are to significantly reduce adult tobacco use in the United States, tobacco control and public health leaders must take a thorough look into this hidden epidemic.

We face many challenges in addressing this issue, including access to health care and the logistical barriers to fully integrating tobacco control into mental health systems. In a 2012 Legacy Report, A Hidden Epidemic: Tobacco Use and Mental Illness, we found that while tobacco use is high for this population, there is limited access to and use of effective prevention and cessation resources as well as a lack of effective tobacco-cessation efforts in the mental health community to help people overcome their addictions to nicotine. The report also found that tobacco control is not a priority within the mental health treatment community. Less than a quarter of outpatients with psychiatric illnesses receive counseling from their physicians aimed at smoking cessation, and in hospitals, only one percent of psychiatric inpatient smokers were assessed for smoking.

While the interim regulations implementing the Mental Health Parity and Addiction Equity Act (MHPAEA) have been in effect since 2010, more guidance is needed. The final rule implementing this important law is needed. Beyond that, there are complex issues surrounding people with mental disorders. For instance, the National Institute of Mental Health says that people with schizophrenia seem to be driven to smoke, and researchers are exploring whether there is a biological basis for this need. Additionally, smoking may make antipsychotic drugs less effective.

Since its inception, Legacy has supported organizations that are addressing this dire need. Some of the solutions we’ve reported on based on our grantee’s effective work include:

  • Training mental health care providers in evidence-based tobacco cessation strategies;
  • Integrating evidence-based cessation strategies into mental health treatment plans;
  • Enforcing smoke-free policies at psychiatric hospitals and clinics; and
  • Assessing smoking status of all people served in psychiatric inpatient and outpatient environments.

While extensive research exists on the effects of tobacco use in the general population, few studies focus on individuals with mental illnesses. Further research is needed to address tobacco cessation efforts in this underserved community. Those who smoke are just as motivated to quit as the general population and they should be given that chance to do so.

Cheryl G. Healton, DrPH
President and CEO

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