BACKGROUND: Smoking rates among individuals with mental illnesses are significantly higher than in the general population and contribute to increased rates of morbidity and mortality.OBJECTIVE:The purpose of this study was to generate a theory of the process by which to lower the prevalence of smoking in this population.STUDY DESIGN:Grounded theory methods, including constant comparison and theoretical sampling, were used to uncover the emerging process of addressing tobacco use in mental health settings from the perspective of national leaders.RESULTS:Participants suggested that the culture in mental health settings around tobacco use significantly contributes to the high rates of smoking and described barriers to and opportunities for culture change.CONCLUSIONS:The findings highlight several windows of opportunity that have begun to be explored. Leaders described current signs of change within mental health settings and expressed optimism about the possibility to lower future rates of smoking among mental health consumers and staff members.
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