Research consistently shows that people living with serious mental illness have a shorter life expectancy than the general population. Australian estimates vary by diagnosis and population, with some studies reporting gaps of 12–20 years or more. The good news is that much of this risk can be reduced with regular health checks, support to quit smoking and care that connects physical and mental health.
This guide is for people living with schizophrenia, bipolar disorder or severe depression, their carers and family, and anyone with another mental health condition who wonders whether it applies to them. The key points:
- A large proportion of premature deaths among people with mental illness are associated with potentially preventable physical health conditions, as mentioned by AIHW.
- Smoking, metabolic changes, missed screening, and disconnected care all play a part.
- Quitting smoking can improve mental health, not just physical health.
- Simple, regular checks catch problems early.
- When GPs and psychiatrists work together, they make the biggest difference.
Why Do People With Mental Illness Die Earlier?
People living with serious mental illness die earlier mainly because of physical conditions that could often be prevented or treated sooner, such as heart disease, diabetes, lung disease, and cancer. The causes lie largely in how health systems, risk factors, and access to care align, not in anything a person has done wrong.
According to the Australian Institute of Health and Welfare (AIHW), almost 80% of premature deaths among people with mental illness are attributable to potentially preventable physical health conditions, including cardiovascular disease, diabetes, respiratory disease and cancer.
The gap varies depending on where you look. A Western Australian population-based study found a 15.9-year life expectancy gap for men and a 12.0-year gap for women in 2005. The study also found that the gap had widened between 1985 and 2005. These are historical estimates, not current national figures.
National bodies often cite “up to 20 years”. Figures vary because studies examined different conditions, populations, time periods, and methods, so a range is more honest than a single number.
The gap is not fixed. Looking after physical health is now seen as a core part of schizophrenia treatment and recovery, and each of the causes below has something that helps.
What Causes the Life Expectancy Gap in Serious Mental Health Illness?
No single factor explains this gap. Metabolic health, smoking, missed screening, and disconnected care combine, and each can be addressed.
Heart Disease, Diabetes and Metabolic Health
Metabolic syndrome is a cluster of risk factors, including high blood pressure, elevated blood sugar, excess abdominal fat, and unhealthy blood fat levels. Together, these increase the risk of heart disease, stroke and type 2 diabetes.
In the Australian Survey of High Impact Psychosis (SHIP), more than half of participants had metabolic syndrome and nearly half (47.4%) were obese. Reported metabolic syndrome rates differ between SHIP papers, so “more than half” is the safest summary.
Some psychiatric medicines can affect weight and metabolism, so it’s worth understanding medication-related weight gain and what helps. Low activity, disrupted sleep, limited income, and limited access to food also contribute.
What helps: regular checks of weight, waist, blood pressure, blood sugar and cholesterol, and early lifestyle support so small changes don’t build up.
Smoking and Substance Use
The second Australian National Survey of Psychosis found that 65.9% of participants were current smokers. Smoking is a major driver of heart and lung disease and several cancers, so it carries much of the physical risk.
What helps: support to cut down or quit, offered without judgment. Many people living with mental illness want to quit, and help works. The section on quitting smoking below explains more.
Missed Cancer Screening
Screening finds some cancers before symptoms appear. A 2024 Australian study examining bowel screening participation between 2006 and 2019 found that 25.7% of people with severe mental illness returned their screening test, compared with 37.4% of people without severe mental illness.
What helps: staying up to date with preventive health and screening checks, with reminders, a support person, or a GP who raises screening at routine visits.
Diagnostic Overshadowing and Disconnected Care
Diagnostic overshadowing happens when a physical symptom, such as chest pain, tiredness, or weight change, is put down to mental illness instead of being investigated. It can delay diagnosis of treatable conditions.
It is closely tied to how stigma affects access to health care for people living with mental illness. The AIHW also notes that mental and physical health services are often separate, and it is not always clear who monitors physical health.
What helps: naming one person responsible for physical health checks, and making sure results and plans are shared between your GP and psychiatrist.
What Is Equally Well?
Equally Well is Australia’s national consensus, supported by governments, professional colleges and organisations, committing to improve the physical health of people living with mental illness.
It recognises that people living with mental illness should have equal access to preventive care, early diagnosis and treatment for physical health conditions. Its aim is that people with mental illness have the same chance of good physical health as everyone else.
Its core idea is simple: physical health is part of mental health care, not a separate task.
The Being Equally Well policy roadmap sets out practical directions, including shared care between services and care navigation to help people move between them. The Equally Well National Consensus Statement is available through equallywell.org.au.
Physical Health Checks for People With Serious Mental Illness
People taking antipsychotic medication may need additional physical health monitoring because some medicines can affect weight, blood pressure, blood sugar, and cholesterol. Checks are particularly important before starting treatment and after medication changes. Your GP and psychiatrist can agree on a monitoring schedule based on your medication and individual risk factors.
Catching changes early can help you access treatment sooner and reduce the risk of complications.
- Weight, waist, and blood pressure: checked regularly, especially when starting or changing medicine.
- Blood sugar and cholesterol: to catch diabetes and heart risk early. If you’re unsure what’s being checked, learn which blood tests are part of physical health monitoring and why they matter.
- Smoking, alcohol and other drugs: ask about support to cut down or quit.
- Cancer screening: bowel screening is available through the National Bowel Cancer Screening Program for eligible people aged 45–74. People aged 45–49 can request a free kit, while those aged 50–74 are automatically sent one every two years. Also keep up to date with BreastScreen and cervical screening.
- Dental and eye checks: these are often missed.
- Vaccinations: flu and others as advised.
- Sleep: snoring or daytime sleepiness is worth raising.
Your GP will tailor the timing to you. The list above is a general guide and not a checklist set in stone.
Tip for carers: bring this list to appointments, and note down results and dates so nothing is lost between services.
Does Quitting Smoking Help Mental Health?
Yes. There is significant research that links quitting smoking with less depression, anxiety, and stress. Quitting also does not appear to make mental health conditions worse, which is a common worry.
Practical steps:
- Call Quitline on 13 78 48 for free advice and support.
- Ask your GP or psychiatrist about stop-smoking support, including medicines that may suit you.
- Tell your prescriber before you quit. The levels of some psychiatric medicines in the body can change when you stop smoking, so your care team may want to monitor you.
Small steps count. Cutting down, setting a quit date or trying again after a slip are all progress.
A 2021 Cochrane review of 102 studies involving more than 169,500 people found that stopping smoking was associated with improvements in depression, anxiety and stress symptoms compared with continuing to smoke. The certainty of the evidence varied across outcomes, but the review found no evidence that quitting worsened mental health in the longer term
Australian research by Greenhalgh et al. (2022) found that smokers with mental illness were generally as likely as other smokers to attempt quitting and more likely to use cessation support. However, they were also more likely to report unsuccessful quit attempts.
How GPs and Psychiatrists Can Work Together
GPs and psychiatrists work best through shared care, where each has a clear role, and information flows both ways. This avoids gaps where no one is sure who is checking blood pressure, screening, or medication side effects.
Who | Role |
Psychiatrist | Mental health treatment, medication management, and monitoring medication side effects |
GP | General physical health checks, preventive screening and chronic disease management |
Dietitian/exercise physiologist | Individualised nutrition and physical activity support |
Carer/support person | Helping with appointments, reminders, and communicating health concerns, with the person’s consent |
Practical Steps to Protect Your Physical Health
Small, steady habits make a real difference, and you don’t need to do everything at once. Pick one ot two to start:
- Book regular GP check-ups and keep a record of your results.
- Start with manageable physical activity, such as a short daily walk.
- Aim for regular, balanced meals.
- Develop a consistent sleep routine.
- Seek support to reduce or quit smoking.
- Attend recommended cancer screening and preventive health appointments
Lifestyle support works. Australian programs such as Keeping the Body in Mind show that early lifestyle support can prevent much of the weight gain after starting antipsychotic treatment. The 2025 Lancet Psychiatry Commission (Teasdale et al.) concluded that lifestyle care should be a core part of mental health care. Lifestyle interventions have also featured in Australian mood disorder guidelines since 2020.
Frequently Asked Questions
Why do people with mental illness die earlier?
People with serious mental illness have a higher risk of physical health conditions, including heart disease, diabetes, lung disease, and cancer. Smoking, medication side effects, missed screening and barriers to healthcare contribute to the life expectancy gap.
What is Equally Well?
Equally Well is an Australian national initiative focused on improving the physical health of people living with mental illness. It promotes integrated healthcare so that physical health receives the same attention as mental health
What health checks are recommended for people with schizophrenia or bipolar disorder?
Common checks include weight, waist circumference, blood pressure, blood sugar, and cholesterol. Dental and eye health, vaccinations and recommended cancer screening are also important. Your GP will tailor the checks to your health needs and medications.
How can GPs and psychiatrists work together?
They can use a shared care plan, exchange health information, and agree on who will monitor physical health, review medications, and schedule follow-up appointments.
Does quitting smoking help mental health?
Research suggests that quitting smoking can improve depression, anxiety, and stress symptoms. Support is available through Quitline on 13 78 48. Speak with your prescriber before quitting because smoking cessation can affect the levels of some psychiatric medicines.
What is diagnostic overshadowing?
Diagnostic overshadowing occurs when physical symptoms are attributed to mental illness instead of being investigated. This can delay diagnosis and treatment of physical conditions.
Can lifestyle changes really make a difference?
Yes. Regular physical activity, balanced nutrition, better sleep, and support for smoking cessation can improve physical health and complement mental health treatment.
This article is general information and does not replace advice from your own doctor.
If you’re struggling or having thoughts of suicide: Lifeline 13 11 14 | Suicide Call Back Service 1300 659 467 | In an emergency, call 000.
To quit smoking: Quitline 13 78 48.
