Table 1. smoking health risks and its implications to Mental Health patients.

Smoking : health risks in MH patients	Implications
Increases risk of other respiratory infections [26] and exacerbates conditions such as asthma. Increase risk of serious complications from COVID-19 [28]	Risk to patients Increased burden on healthcare service
Reduces efficacy of many psychiatry medications [29]	Poor mental health symptom control Need for higher doses of medications giving more side effects Need for more blood tests for measuring drug levels e.g.: Clozapine
Contributing and worsening factor for mental illness [29]. Increased likelihood of smoking during COVID-19 due to lockdown and related stress.	Increased patient distress and burden on mental health staff
Increase long term risk of cardiovascular and respiratory diseases, and cancers [3].	Smoking is the single largest contributing factor for reducing the life span of those with severe mental illness by 10-20 years.
Increases risk of ex-smokers relapsing back to smoking due to the stress [23] and peer pressure in inpatient settings as a result of relaxed smokefree policies during COVID-19.	All the hard work put in to quit smoking reversed. Can take many years to get the culture to change back again to enable mental health hospitals to convey the positive health messages.