The National Partnership on Behavioral Health and Tobacco Use

Healthier, Smoke-free Lives for People with Mental Illnesses and Substance Use Disorders

Who We Are

The National Partnership on Behavioral Health and Tobacco use represents clinical organizations, government agencies, non-profit and advocacy groups, corporate, and philanthropic foundations, all committed to expand and accelerate efforts to combat disparities in tobacco use and tobacco treatment services for individuals with mental health and/or substance use disorders.

Our Purpose

Individuals with mental illness and/or substance use disorders (behavioral health) represent 25% of the Nation’s population, yet they consume 40% of all cigarettes sold in the US. Half a million Americans die each year due to tobacco use – half of whom are individuals with a behavioral health condition.

Adults who smoke cigarettes 10 years earlier than those who don't smoke on average (Source: CDC Fast Facts). Recognizing that this epidemic is a social justice issue, the American Cancer Society (ACS) and the Smoking Cessation Leadership Center (SCLC) convened national leaders from tobacco control, public health and the behavioral health sectors to develop a plan that expands and accelerates efforts to combat disparities in smoking prevalence and treatment for those with mental health and/or substance use disorders. Thus, the National Partnership on Behavioral Health and Tobacco Use was born.

Having reached the target of 30% well ahead of schedule – smoking prevalence in the behavioral health population fell to 30.5% in 2017– the National Partnership adopted a more ambitious target to reduce smoking rates to 20% by the year 2022.

ACS and SCLC co-hosted a first-of-its-kind, multi-sectoral summit at ACS’s global headquarters in October 2016, where the new national partnership adopted a goal of reducing smoking prevalence in the behavioral health population in the U.S. from 34.2% in 2015 to 30% in 2020. (Source: United States Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Center for Behavioral Health Statistics and Quality. National Survey on Drug Use and Health, 2017. Research Triangle Park, NC: RTI International [distributor.) The participants included senior leaders of health professional organizations, federal agencies, not-for-profit health organizations, managed health care companies, and experts in behavioral health and tobacco prevention and cessation.

Current Smoking Among Adults (age> 18) with Past Year Behavioral Health (BH) Condition

Baseline: 30.5% (2017) Target: 20% by 2022

When the smoking rate among the behavioral health population dropped to 30.5% in 2017, the Partnership convened its second summit in November 2018 with an expanded roster of 24 members. An ambitious new target, along with specific strategies to reach that ambitious goal, was set to reduce smoking rates to 20% by the year 2022 (“20 by 22”).

The most recent data from our partners at SAMHSA shows that current smoking among adults with a behavioral health condition continues to decrease at a statistically significant level. In 2019, NSDUH data provided by Doug Tipperman shows that 28.9% of adults with any behavioral health condition smoked. This is down from 30% in 2018.

In 2021, NSDUH data provided by SAMHSA shows that 26.8% of adults with any behavioral health condition smoked. Due to DSM-V definitions used beginning in 2020, the data is not directly comparable to previous years -- however the National Partnership still recognizes this as continued progress and a positive step toward eliminating disparities in tobacco dependence in the U.S.

Our Strategy

The Partnership’s 2023 action plan consists of multiple strategies in four categories:

Systems Change
Policy Change
Diversity Amongst Providers and Discipline
Education and Translation into Practice

Each of the participating organizations pledged to undertake specific actions towards further reducing smoking prevalence among individuals with behavioral health conditions, and multiple collaborative activities were planned. The collaborative efforts designed by the Partnership range from trainings, public communications and program implementation, to the issuance of policy statements and educational offerings.

Partnership Progress

Examples of Strategic Actions

Policy

The National Association of State Mental Health Program Directors (NASMHPD) adopted a groundbreaking national policy statement strongly recommending that all behavioral health settings be tobacco-free and offer smoking cessation services. The policy applies to all state mental health programs and facilities in the U.S. This statement led to an overall increase in state efforts to implement state-based policies for behavioral health treatment settings.
HUD implemented a historic rule in July 2018 that created a sweeping smoke-free policy for all public health authority (PHA) locations. This policy eliminated the use of all combustible (burned) tobacco products in all public housing living units, indoor common areas in public housing, and in PHA administrative office buildings. Multiple national partners – including the ACS, the SCLC, the ALA and the NAQC, among others – are collaborating with community health centers, promoting the use of toll-free quitlines and employing other resources to aid residents in quitting. They are also helping to guide and support PHAs and their residents in reinforcing effective community adherence to the new smoke-free standard.
VA has implemented smoke-free policies in all VA medical centers for patients, including hospitals, clinics and nursing homes (as of October 2019)
Public Health Law Center and SCLC conducted surveys with state health representatives across the U.S. in order to compile the number of U.S. State laws requiring tobacco-free grounds for mental health and substance use treatment facilities. This informational chart has been published and available here. PHLC continues work to expand state, local, and provider tobacco-free grounds and cessation integration policies in behavioral health and substance treatment facilities.

Treatment

Optum developed and implemented a program for smokers with behavioral health conditions. This special offering includes combination NRT, additional coach training and a specialized coach team, connection with a participant’s mental health provider or primary care provider. A pilot study was published in Nicotine and Tobacco Research in 2019 showing that the program increased engagement with treatment and use of NRT. As of March 2020, iterations of this program are available through state quitlines in Maine, Minnesota, Florida, Indiana, North Carolina, South Carolina and Washington and is being promoted by the Partnership.

Communication

The National Partnership has widely disseminated and promoted two guides developed by SAMHSA, "Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings" and "Implementing Tobacco Cessation Treatment for Individuals with Serious Mental Illness." In addition to these tools, numerous resources developed by member organizations and other national partners have been promoted by the National Partnership on an ongoing basis.
Truth Initiative continues its nationwide, digital smoking cessation service, BecomeAnEx, targeting populations still most likely to smoke.
The National Partnership on Behavioral Health and Tobacco Use submitted a joint public comment to the Centers for Medicare and Medicaid Services (CMS), urging the agency to retain two important tobacco measures as quality indicators (TOB-1 and TOB-3). Due to the public comment response, CMS retained the tobacco measure regarding tobacco use at discharge (TOB-3), allowing health professionals to be reimbursed for providing this service – a critical component of ensuring more robust delivery of tobacco treatment services.
The Communications Committee for the National Partnership has put together a campaign with the hashtag #20by22. A general communication packet for the Communications Toolkit explains how this new goal will be achieved. Read the summary statement and the National Partnership Presentation for more information.

Data

The smoking prevalence among adults with a behavioral health condition in the United States has been reduced from 34.2% in 2015 to 30.2% in 2018 (Source: NSDUH), nearly surpassing the Partnership’s original target of 30% in 2020. Due to this progress, the Partnership adjusted its target to an ambitious 20% by 2022.
NAQC is collecting data on the number of adults with behavioral health conditions who smoke and are served by quitlines
CDC OSH is adding data from N-MMHS and N-SSATS to the OSHData system and creating a State Fact Sheet on Tobacco-related Policies and Practices in Behavioral Health Facilities

Strengthening Strategies

SCLC has been designated as a National Center of Excellence for Tobacco-Free Recovery by SAMHSA and will continue to hold State Leadership Academy summits as well as provide on-going technical assistance (to reduce smoking prevalence among behavioral health populations in specific states, particularly those in Tobacco Nation) under this banner. SCLC, in partnership with National Behavioral Health Network and SAMHSA, has held Leadership Academy summits in 20 states since 2010.
With SAMHSA support, two national trainings are being held in August 2020, titled "Creating and Enhancing Tobacco-Free Facilities and Treatment Services," with the purpose of educating behavioral health treatment staff on the importance of addressing tobacco use among their clients and establishing tobacco-free campus policies at their sites.