Persons with a mental illness are one of the largest remaining groups of smokers, comprising an estimated 32% of the total smokers in Australia . Consistently high rates of smoking have been found among the mentally ill in Australia and internationally, ranging from 36% in community samples to above 90% among inpatients with psychosis [2–5]. Smokers with a mental illness are also more nicotine dependent , more likely to smoke unfiltered cigarettes  and less likely to quit than smokers in the general population [8–10]. Consequently, smokers with a mental illness have a significantly reduced life expectancy and are more likely to die from smoking related disease including cancers, cardiovascular disease, respiratory disease and stroke [11, 12].
Evidence for the effectiveness of multimodal smoking cessation interventions utilising combined pharmacological and psychosocial support is well established for smokers in the general population [13–15]. Recent evidence suggests that smokers with a mental illness have similar levels of motivation to quit as the general population [16–18] and smoking cessation intervention strategies can be equally effective among this group [19–21]. Multimodal smoking cessation interventions have been found to be effective among US veterans with Post-Traumatic Stress Disorder (PTSD) , depressed smokers , and in smokers with schizophrenia .
General hospitals can provide a base for the initiation of effective smoking cessation interventions [25–28]. Abstaining from tobacco during hospitalisation has been associated with higher abstinence rates at 6 months post discharge . The recent introduction of smoke-free policies in Australian mental health facilities  provides the opportunity for smokers to temporarily abstain from cigarettes in a supportive environment, and may facilitate sustained cessation attempts upon discharge [2, 31]. Hospitalisation within a smoke free mental health facility has been found to increase patients' desire to quit smoking during admission [4, 31], and has been associated with a reduction in daily cigarette consumption from admission to discharge .
However, the limited data available indicate that smoke-free policies in mental health facilities appear to have had little effect on long term cessation , a finding suggested to be due in part to the lack of coordination between inpatient and community smoking cessation treatment [32, 33]. Systematic reviews show that by better integrating inpatient smoking care with post discharge cessation support, long term quit rates are increased among general hospital patients [27, 28]. However, in the context of mental health services, low levels of smoking cessation treatment have been found in both inpatient and community-based psychiatric services [34–36], and as a consequence, many smokers return to pre admission smoking levels upon discharge from a mental health hospital [4, 31, 37]. The limited provision of smoking cessation treatment in community-based psychiatric services, to which many patients are likely to be referred upon discharge, highlights the need for integrated post-discharge smoking cessation treatment for smokers with a mental illness [32, 33].
Although an Australian randomised control trial of outpatients with psychosis reported that a multimodal smoking cessation intervention was effective in reducing smoking rates , the authors are not aware of any published studies that have examined the effectiveness of integrating inpatient smoking cessation care with community cessation support for individuals with a mental illness. This study is the first of its kind internationally to test, via randomised controlled trial, the feasibility, acceptability and efficacy of integrating inpatient smoking care with post discharge ongoing, multimodal smoking cessation treatment for persons with an acute mental illness. This paper describes the methodology to be employed in the conduct of this trial.