Background and challenges to implementation:
One of the greatest disparities is high smoking prevalence in the behavioral health (BH) population - individuals with mental illness and/or substance use disorders. Despite progress in lowering the rate of tobacco use overall, smoking prevalence in the BH population in the US is 34%, more than double the national average. The BH population accounts for 240,000 of the 540,000 annual deaths from smoking. BH sufferers die 10 to 25 years earlier than the general population, mainly from smoking-related diseases. Traditionally, health professionals, governmental agencies and advocacy groups have not identified BH sufferers as a priority population for promoting smoking cessation.

Intervention or response:
The American Cancer Society (ACS) and the Smoking Cessation Leadership Center (SCLC) at the University of California, San Francisco, launched a multisectoral partnership in 2016 at a summit attended by 16 national health professional groups, federal government agencies, civil society groups and individual experts in tobacco control and BH. The participants established a new initiative to promote prevention and cessation in the BH population through networking, education and clinical guidance. ACS and SCLC lead this collaboration and are developing the necessary infrastructure to sustain it. Every participant commits to taking specific actions to enhance collective communications and educate and guide their constituencies of professions and consumers.

Results and lessons learnt:
The alliance of organizations reviewed smoking prevalence and health impact on the BH population, and best practices for reducing tobacco use. It then adopted the ambitious goal to reduce smoking prevalence in the behavioral health population in the US from 34% to 30% by the year 2020.

Conclusions and key recommendations:
22 million US smokers suffer from BH conditions. Reducing their prevalence to 30%, or 19.5 million smokers, would result in 2.5 million fewer smokers, saving over a million lives. This unique collaboration endeavors to significantly reduce smoking prevalence and has the potential to be replicated globally.