Tobacco use results in numerous consequences for individuals with mental illnesses and other substance use disorders, yet it is not adequately addressed by behavioral health professionals, including psychiatrists. This column describes current inaction among behavioral health professionals and some possible reasons for it and recommends next steps. Psychiatrists should provide treatment for all patients with a co-occurring tobacco use disorder and provide leadership to change policies and practices in treatment centers. Psychiatrists can be vital leaders of the effort to reduce the toll of tobacco use among people with mental illnesses, addictions, or both. A national movement for addressing tobacco use in the behavioral health field can be galvanized if more psychiatrists participate.