How Australia Is Failing People With Mental Illness Who Smoke

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Key Points:

• Study Findings: Health Expectations interviews with 17 Australians with mental illness reveal smoking is used to cope with anxiety, depression, loneliness, and stress – yet all agreed life was better after quitting.

• Double Stigma: Participants saw cigarettes as both relief and burden, offering social connection but reinforcing shame and exclusion.

• Support Needed: Smokers with mental health conditions want more than nicotine withdrawal aids – calling for counseling, peer groups, stress management, and harm reduction approaches.

• National Context: People with mental illness are twice as likely to smoke daily (15.4 percent vs. 7.4 percent); nearly 1 in 3 smokers report a past-year mental disorder.

• Policy Gap: Australia’s 2025 budget largely ignored the mental health – smoking link, extending only modest digital services while youth disorders surge.

• THR Restrictions: Harsh vape bans and excise taxes have fueled a $10 billion AUD illicit tobacco market, violent robberies, firebombings, and falling tax revenues.

• Critical Crossroads: With smoking entrenched among vulnerable populations, punitive bans leave only cigarettes or the black market; holistic, harm-reduction policies are urgently needed.

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A new study published in Health Expectations is providing important insight into smoking cessation among people diagnosed with mental illness. The researchers set out to explore how individuals with mental health conditions experience tobacco use and quitting, why they smoke, what motivates them to stop, and what forms of support they find helpful or lacking. Using in-depth, semi-structured interviews with 17 adults in Queensland – all of whom had a mental health diagnosis and at least one quit attempt in the past five years – the study highlights the complex interplay between tobacco use, mental health, and recovery.

Participants described smoking as strongly tied to managing anxiety, depression, loneliness, and stress. For many, cigarettes were seen as a “dependable” relief, even as they recognized the shame, low self-esteem, and self-neglect associated with smoking. Withdrawal often made anxiety worse, creating additional barriers to cessation. Smoking also carried a double stigma: while it offered social connection, routine, and bonding with other smokers, increasing restrictions and public disapproval left many feeling like outcasts, compounding the stigma already tied to their mental health conditions.

The study revealed contradictions in how participants viewed smoking. They recognized its harms – health consequences, financial strain, and social shame – yet continued to rely on it for psychological relief. Still, all participants agreed that life was better without cigarettes. Quitting brought improved health, stronger finances, freedom from stigma, and more fulfilling social connections.

What they called for, however, was support that goes beyond nicotine withdrawal. Participants emphasized the need for counseling, peer groups, stress management strategies, and other coping mechanisms. Many argued that smoking bans, especially in inpatient mental health settings, were ineffective, coercive, and often led to relapse after discharge. Instead, they favored comprehensive approaches that combined nicotine replacement therapies with psychological support. One participant went further, urging policymakers to adopt harm reduction principles for tobacco, similar to approaches used in alcohol and other drug policy.

These findings resonate with broader national data. According to the Australian Bureau of Statistics, nearly half of Australians aged 16 to 85 have experienced a mental disorder at some point in their lives, and more than one-fifth had a past-year mental disorder, with anxiety the most common. Among young Australians aged 16 to 24, almost 39 percent reported a past-year mental disorder. People with mental health conditions remain twice as likely to smoke: in 2022-2023, 15.4 percent of those with a condition smoked daily, compared to 7.4 percent of those without. Among current smokers aged 16 to 85, nearly one in three reported a past-year mental health disorder, compared to just one in five among those who had never smoked.

Despite this clear overlap between mental health and smoking, Australia’s latest federal budget failed to prioritize the scale of the problem. While billions were directed toward general healthcare, the only new mental health initiative was a modest extension of digital mental health services. Calls for free mental health care for people under 25 – who face the highest rates of mental illness – went unanswered, leaving experts warning of a dangerously inadequate response to a growing national crisis.

At the same time, the government has tightened restrictions on tobacco harm reduction products. Since July 2024, e-cigarettes – whether nicotine-containing or not – have been restricted to pharmacies only. This followed a January 2024 ban on the importation of disposable vapes and a March 2024 ban on all vaping imports.

Combined with some of the world’s highest cigarette excise taxes, these restrictions have fueled a thriving black market. Australia now faces a $10 billion AUD illicit tobacco industry, with illegal products making up an estimated half of all cigarettes consumed. The consequences are visible and violent: robberies in some regions have surged by more than 150 percent, and more than 125 firebombings of tobacco shops have been recorded in Victoria alone, with dozens more across other states. Meanwhile, government tobacco tax revenues have collapsed, falling to $7.4 billion AUD in 2025 – a 15 percent decline in just six months.

Australia is now at a crossroads. On one hand, a mental health crisis is deepening, with young people disproportionately affected and more likely to smoke. On the other, policymakers are stripping away access to safer alternatives that could help those unable or unwilling to quit.

Participants in the latest study made clear that people with mental health conditions want to quit smoking, but they need compassionate, holistic, recovery-oriented support. What they do not need are punitive bans and draconian restrictions that leave them with only combustible cigarettes or the black market. Real progress requires moving beyond a “quit or die” framework toward policies that reduce harm, support self-determination, and recognize the lived realities of those most at risk.

Nothing in this analysis is intended to influence the passage of legislation, and it does not necessarily represent the views of Tobacco Harm Reduction 101.