Smoking is one of the most significant causes of poor physical health and is the single largest cause of premature death for people living with serious mental illness (SMI). In England, 40.5% of people living with SMI are smokers, compared to approximately 15.5% in the general population [1]. People living with SMI are also likely to smoke more heavily. Smoking increases the risk of various physical health conditions (such as cardiovascular disease, cancer and type 2 diabetes). In turn, these increase the risk of further mental ill health and reduce wellbeing and life expectancy.

Individuals living with SMI have failed to benefit from population efforts to reduce smoking. Smoking rates remain high across this population. This is despite a steady decline in the general population over the past 40 years. Innovation is required to unite sectors and healthcare settings to increase stop smoking advice coverage and interventions in the most cost effective and meaningful way possible.

Reducing smoking rates in people with SMI is probably the single most important activity to reduce the mortality gap. It is a national priority outlined in NHS Five Year Forward View, Five Year Forward View for Mental Health and Five Year Forward View for Public Health.

Creating change and addressing the unacceptable gap in life expectancy will require a whole-system approach. It will need to support the delivery of smoking interventions to address culture and stigma, screening rates, treatment rates and treatment efficacy. We also need to ensure interventions are implemented to prevent the uptake of smoking in the first place.  These would include providing information, extra support, training of professionals, smoke-free environments and role modelling non-smoking behaviour.

Recommended actions

We have developed key recommendations that will support system change and effectively address the serious mental illness (SMI) mortality gap. Follow the links for more information and tools to support you:

These recommendations are in addition to those stated under the main prevention section.

Helpful tools and resources

Related policy:

  • ‘No health without mental health: implementation framework’. Encourages services to address mental health service users’ physical health and local public health campaigns to target people with mental health problems.
  • Local Tobacco Control Profiles. Public Health England publish Local Tobacco Control profiles for each CCG, to help local government and health services to assess the effect of tobacco use on their local populations. This is particularly relevant for people with SMI.


[1]   PHE Local Tobacco Control Profiles. Original data from the HSCIC: Smoking rates in people with serious mental illness.  (By Clinical Commissioning Group) (Dataset 1.23)




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