Individuals with severe mental illness smoke cigarettes at rates twice as high as the general population, greatly contributing to the 25-year difference in life expectancy for this population. However, smoking cessation programs often exclude these individuals, in part because of the difficulties associated with providing such treatment.

Clinicians at a safety-net hospital in California, Zuckerberg San Francisco General Hospital (ZSFG), found there were enormous inequities in services 

provided to those in inpatient psychiatric units versus other patients in the hospital. Almost all patients on inpatient units who were smokers received smoking cessation treatment or counselling by a dedicated team of licensed vocational nurses. However, on the inpatient psychiatric units, less than 10% of smokers received such treatment and there were no dedicated teams of professionals. The clinicians decided that tackling the toughest challenge is the only option, publishing evidence of their success in this month's Psychiatric Services.

The authors encountered many challenges in trying to implement this program. They initially approached the dedicated smoking cessation teams on the other medical and surgical inpatient units to expand the program to the psychiatric units. However, the staff were resistant and said they were not prepared to work with patients on a locked psychiatric unit.

Instead, the study authors decided to create an independent smoking cessation program for the psychiatric unit, utilizing the clinicians already on staff in the unit. However, a survey of the inpatient psychiatric providers revealed most did not believe smoking cessation treatment was a worthwhile part of their practice and had low confidence in the success of a program, commenting things like: "there are other priorities to address on an inpatient psychiatry unit like substance abuse counseling and reducing self-harm behaviors and psychotic symptoms."

However, the clinicians pressed on in their efforts. They developed a flow-chart system to identify, prioritize and track patients on the psychiatric unit. This allowed the providers to revisit a patient throughout their hospitalization as their psychiatric symptoms decreased and they may be more amenable to smoking cessation treatment. The authors also provided educational sessions to providers on the efficacy and importance of smoking cessation treatments for these patients.

After four months of initiating the program, more than 80% of patients on the psychiatric unit received smoking cessation treatment, a significant increase to the 10% of people who had received it prior. Importantly, after the implementation, most providers believed the smoking cessation treatment was a worthwhile part of their practice.

The results reveal the importance of prioritizing treatments for the most vulnerable of individuals and not accepting challenges and difficulties as an excuse of passing these individuals by. With more of this type of effort, we may be able to make a difference in the major inequities in life expectancy and quality of life for people with severe mental illness.