Smoke and mirrors

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Smoke and Mirrors book cover

As more Australians quit smoking and more areas become smoke-free, some exceptions stood out – people with mental illness, and they facilities in which they were cared for in the bad times. Until recently, people with mental illness were still seen as needing to smoke, as benefitting from smoking, as being unable to quit smoking. They were given cigarettes ‘to help’ them, and were actively discouraged from quitting.

Mark Ragg and Tanya Ahmed were commissioned by Cancer Council NSW to examine the evidence around smoking and mental illness. Did smoking really help? Did nearly all people with mental illness smoke? Did they find it impossible to quit? The answers were no, no and no. This was our conclusion.

Is there a problem?

Yes, there is a problem. Although prevalence data is often old and inexact, it is clear that some groups of people with mental illness are more likely to smoke than the average person.

Is the problem significant?

Yes. Smoking-related diseases are a major cause of death for people with mental illness. Smoking is also an enormous financial stress on people who, in some cases, have very limited financial resources.

Can anything be done?

Yes. We believe that:

  • every person with mental illness should be asked whether they smoke or not
  • every person with mental illness should be advised of the risks of smoking and the benefits of quitting
  • every person with mental illness should be offered help to quit smoking
  • no person with mental illness should ever be encouraged to smoke.

Are there any risks?

Yes. The risks of smoking to people with mental illness are considerable and far outweigh any possible benefits, should there be any.

The benefits of quitting for people with mental illness are considerable and far outweigh the risks of quitting, should there be any.

We can find no evidence to support the notion that any person with mental illness should not be encouraged to quit smoking, or should be advised not to quit.


This literature review convinced Cancer Council NSW to act, and that organisation convinced NSW Health to act. Smoke and Mirrors, which you can download here, was a catalyst for a change in policy in NSW and around Australia, with people with mental illness now getting the support they would like to quit smoking.

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Mark Ragg
Location: Sydney, Gadigal land
Description: Write, edit, research | Yulang Indigenous Evaluation with @MegBastard | Adjunct Fellow Indigenous health @UTS | Ragg & Co | Equity, justice
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