Smoking in the general population is on the decline. However, in people with severe mental disorders (SMDs) such as schizophrenia and bipolar disorder the estimated smoking prevalence rate is anywhere between 50-80%. High rates of medical morbidity and severely reduced life expectancy are associated with increased prevalence rates in these individuals. Pharmacological treatments for smoking cessation are effective in the general population. We have blogged extensively about the efficacy, tolerability and cost-effectiveness of the three main treatments; transdermal nicotine patches (TNP), varenicline and bupropion. There is emerging evidence to suggest individuals with SMDs are often motivated to quit and pharmacological treatments in those with SMDs are similarly effective. Despite these promising findings, treatments are often under-utilised, with one study finding less than one third of clinicians advising patients about smoking cessation.