An estimated five million deaths worldwide will occur from tobacco consumption in 2006. This figure is projected to reach 10 million deaths annually by 2020.1 Smoking is also the largest single cause of preventable illness and premature death in the United Kingdom, with 106 000 people dying of smoking related diseases in 20022 and more than 10 000 dying each year as a result of passive smoking.3 The Health Act 2006 will make all enclosed public and work places in England and Wales smoke-free environments and represents an important step forward for public health.

Consultation on exemptions to the Health Act continues until October 2006. Among proposed exclusions are mental health units that provide long term accommodation (defined as not less than six months) as well as prisons, care homes, and hospices. We applaud the government for not exempting mental health settings in their entirety as has happened in some other countries that have introduced smoke-free legislation. Making mental health units smoke free ensures improved physical health of mental health patients and protection …