Smoking rates in America have fallen dramatically over the past few decades. But while that’s true for the general population, it’s not the case for all demographic groups.

That’s why the Kansas Health Foundation recently started an effort to decrease tobacco use among a group that smokes more than any other: people with mental illnesses.

Kansans with mental illnesses are twice as likely to smoke as the general population, according to Jeff Willett, vice president for programs at the Kansas Health Foundation and co-author of a recent paper on the topic in the Journal of American Medical Association Psychiatry. They also consume more tobacco, accounting for one out of every three cigarettes smoked across the state. People with serious mental illnesses die an average of 25 years earlier than everyone else, largely from treatable conditions such as nicotine addiction and obesity, according to the National Association of State Mental Health Program Directors.

“The paper is really a call to action for the mental health and public health communities to address the issue of tobacco use among people with serious mental illness,” said Willett. “Preventing and reducing tobacco use is one of the key goals of the Kansas Health Foundation. In order to achieve our goal of reducing tobacco use … we have to make progress with that population.”

Even though smoking rates are down, tobacco use is still the leading cause of preventable death in Kansas, taking the lives of one in seven people per year. Last year, more than 3,600 Kansans lost their lives from tobacco use. “54,000 Kansas children alive today will ultimately die of a tobacco-related disease,” Willett added.

Tackling the issue of smoking among the mentally ill won’t be easy. Cigarette use has at times been accepted in the mental health community as a stress reducer or a way to reward patients for complying with treatment. In addition, kicking the nicotine habit can be difficult for people already struggling with a mental illness.

“If you are coping with some overwhelming problem in your life, to cope with the withdrawal and problems associated with quitting smoking just adds to that,” said David Johnson, CEO of Bert Nash Community Mental Health Center in Lawrence. He acknowledged that something needs to be done to address the problem. “Among those people that we serve who have a serious and persistent mental illness, the prevalence (of tobacco use) is high.”

Bert Nash has been taking a more holistic approach recently, including partnering with Heartland Community Health Center to give its patients access to primary care providers. “The whole issue of improving people’s health is something we are very committed to. Smoking cessation needs to be a piece of that,” Johnson said.

At the state level, the Kansas Health Foundation is bringing together a range of stakeholders, from mental health to tobacco control, to come up with solutions for reducing smoking rates among the mentally ill.

A combination of medication and counseling can help people with mental illnesses overcome their addictions to nicotine, said Kimber Richter, associate professor of preventive medicine and public health at the Kansas University Medical Center.

“The challenge is really how to get treatment to people with mental illnesses and substance abuse problems,” she said, noting that the two groups put together account for half of all cigarettes smoked in the U.S. “How do you get the whole system to start thinking about tobacco?”