Abstract

Restrictions on the sale, advertising and public use of tobacco products, public health messaging and widespread availability of effective treatments have all contributed to the lowest population smoking rate ever (11.1% smokers and 28.4% ex-smokers 55.9% never smoked, CHO Qld 2018). The significant disparity in smoking prevalence between the general population and people experiencing mental illness in Australia has been known for some time and despite our current efforts, that gap may be widening (56% smokers in mental health inpatient units, Qld 2017).

Considering the changes over the last 30 years it appears that public policy, pricing restrictions and messaging have had the biggest effect. Why hasn’t this effect been achieved for people living with a mental illness?

This paper will explore the history of the relationship between the mental health system and tobacco and asks what further changes we need to make in public policy to achieve parity: setting targets, priorities for services, different messaging, outright bans, legislative change including new technologies. Should we modify our clinical approach to include harm minimisation for more people and do new technologies such as vaping offer a panacea or are they a dangerous flirtation?