Smoking is widely known as an architect of well-documented, negative health outcomes. The advent of legislated actions to ban work- and public-place smoking has reduced the overall smoking prevalence in Canada and around the world. However, what is often overlooked are patients with psychiatric illness who are confined in psychiatric institutions and are not able to take advantage of designated smoking areas. The aim of this commentary is to raise awareness of potential inequitable conditions that are inherent in workplace smoking restrictions particularly for psychiatric patients. A biological and social equity perspective will frame the discourse of the issue.