Do programmes for quitting smoking (smoking cessation) work for people who are in hospital for treatment of mental illness?

Key messages

• Offering counselling plus nicotine replacement therapy (a treatment that provides nicotine in a safer form than tobacco smoking to help people reduce cravings and withdrawal symptoms), during a stay in a psychiatric ward, and continuing this support after leaving hospital, may help more people to stop (quit) smoking tobacco (when measured six months later) than usual care.

• We did not find enough information to draw conclusions about the effects of any other smoking cessation interventions initiated in the psychiatry inpatient setting. We need more, better designed studies that test different ways to help people quit smoking, particularly medicines.

Why is smoking a problem for people with mental illness?

People experiencing mental illness die up to 15 to 20 years earlier than people in the general population from preventable physical illnesses, such as heart and blood vessel disease, airway and lung disease, diabetes, and cancer. Smoking tobacco is one of the main causes of these illnesses. People being treated in hospital for mental illness smoke more than people in the general population and are less successful at quitting, despite wanting to stop. Many hospitals are smoke-free environments and should be a good place to deliver quit-smoking programmes to people with mental illness.

What did we want to find out?

We wanted to know whether quit-smoking programmes started while people are being treated in a hospital psychiatry ward help these people to stop smoking, and which programmes are most effective. We were particularly interested in how many people were still not smoking after six months and whether anyone suffered any serious unwanted effects, such as death or a life-threatening event.

What did we do?

We searched for studies that investigated any quit-smoking programme started in a psychiatric ward compared to usual care, being put on a waiting list, or receiving a placebo (a ‘fake’ medicine with no active ingredients). People taking part could have any psychiatric diagnosis but had to be adults (aged 18 years and older) who were tobacco smokers.

We summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes.

What did we find?

We found 10 studies that included a total of 2262 people in emergency or long-stay psychiatry wards. Most studies included people with a variety of mental health diagnoses (for example, mood disorders, anxiety disorders, schizophrenia), and three studies involved only people with schizophrenia or schizophrenia-type disorders. The studies took place in five countries (Australia, USA, Taiwan, Israel, and Iran).

The programmes included:

• counselling plus nicotine replacement therapy and continued support with quitting smoking after leaving hospital (versus usual care);

• a group behavioural (psychological support without medicine) smoking reduction programme (versus being put on a waiting list);

• medicines including bupropion (versus placebo) or cytisine (versus nicotine replacement therapy);

• comparisons between different types and doses of nicotine replacement therapy.

Main results

Counselling plus nicotine replacement therapy together with continued support after leaving hospital compared with usual care (5 studies, 1611 people):

• may increase the number of people who are still not smoking six months after leaving hospital by about 6 more people per 100; and

• may result in fewer deaths (1 less death per 100 people), but this result is very uncertain.

What are the limitations of the evidence?

Our results are based on a limited number of studies, and our confidence in the evidence is low. We had very low confidence in the result for deaths because there were very few deaths in the studies.

Anti-smoking medicines, such as varenicline, have previously been shown to work for people with mental illness in the community, but we found no studies that tested their use in a hospital psychiatry ward.

How up to date is this evidence?

This review is up to date to 10 February 2026.