7 October 2025

People living with a severe mental illness (SMI), such as schizophrenia or bipolar disorder, face significantly poorer physical health outcomes than the wider population. Evidence shows they are five times more likely to die prematurely, with two out of three deaths caused by preventable physical illnesses, such as cardiovascular disease, diabetes, respiratory conditions, liver disease, and cancer. 

To better understand and address these disparities, the King's Health Partners (KHP) Mind & Body Programme conducted a review in south east London. Drawing on national, regional, and local data, the review maps the scale and nature of physical health inequalities affecting adults with SMI, highlighting both common patterns and borough-level variation. 

What was the aim of the KHP Mind & Body physical health in SMI review? 

This work directly supports KHP’s new strategic priority for population health and aligns with wider system ambitions to reduce premature mortality, embed proactive and personalised care, and tackle entrenched inequalities. It also informs targeted interventions across South East London Integrated Care System (SEL ICS), including cancer screening access, multimorbidity management, and the development of a core offer for physical health in mental health settings. 

The review set out to explore the scale and nature of physical health inequalities for adults with SMI in south east London. It developed a comprehensive picture by combining a literature review with analysis of national, regional, and local datasets. Key sources included the Quality Outcomes Framework, the Office of Health Improvement and Disparities’ Fingertips tool, Joint Strategic Needs Assessments, and the SEL ICS dashboards. Together, these sources illustrate how health outcomes for this group compare to the wider population, and where local variation adds further complexity.   

What were the findings of the physical health in SMI review? 

The findings confirmed stark inequalities, with national data highlighting a severe mortality gap: 

  • People with SMI are five times more likely to die before 75 than those without SMI; 
  • two in three deaths in this population are linked to physical illness, with cardiovascular disease the leading contributor; 
  • respiratory disease is common. 19.9% of people with schizophrenia experience chronic obstructive pulmonary disease (COPD), and 7.5% experience asthma. 
  • diabetes affects 11–15% of people with SMI, while hypertension is reported in 32–36% of people; 
  • the burden of liver disease is especially marked, with deaths occurring at five times the rate of the wider population; and 
  • cancer presents a distinct challenge: diagnosis rates are lower but mortality is twice as high, suggesting barriers in early detection and treatment. 

This national picture is mirrored in south east London. Local data shows that people with SMI across the six boroughs experience high levels of multimorbidity, with obesity, diabetes, cardiovascular disease, and respiratory illness all common. Mortality patterns reflect national trends, with preventable physical illness driving most early deaths.   

However, local data reveals specific issues. Respiratory illness is a particular concern: asthma admission rates are relatively low, but COPD admissions and mortality are higher than in many other London boroughs, particularly in Southwark. Cancer outcomes also raise concern, with admissions and deaths closely aligned - a pattern that may indicate later presentation and poorer survival.   

By integrating national evidence with local insights, the review presents a clear and urgent picture of entrenched inequalities in physical health for people with SMI. Furthermore, the review highlights areas where local factors may intensify these challenges.   

Given these findings, the review identified seven priority areas in SEL: 

  • deprivation; 
  • geography and environment;  
  • multimorbidity;  
  • ethnicity;  
  • gender;  
  • life-course needs; and 
  • equitable access to care. 

Alongside these, three enablers were highlighted: improving data quality (coding, completeness, and interoperability), ensuring lived experience is embedded, and using integrated care systems to act on inequalities.   

How have the physical health in SMI review finding made a difference for staff and patients? 

Insights from this review have informed a South East London Cancer Alliance (SELCA)-funded mixed-methods study. This new study aims to understand barriers to screening and diagnostics, with co-developed interventions planned for testing in 2026-7. Findings from the physical health in SMI are also supporting targeted interventions and investment cases for those affected by SMI, obesity, diabetes and hypertension. 

Through this work KHP Mind & Body has shaped a core offer for physical health in community mental health settings, co-developed with South London and Maudsley and Oxleas NHS Foundation Trusts. This seven-standard framework is now being scaled across SEL ICS, supported by Communities of Practice and a Train-the-Trainer programme. 

Together, these efforts form a coordinated system response to reduce the mortality gap and improve physical health outcomes for people with SMI. 

 The full report can be downloaded from Mind and Body's Future NHS Workspace or by contacting mindandbody@slam.nhs.uk .