Body and Mind: Why Physical Health Markers Matter in Serious Mental Illness
People with severe mental illness die 10 to 20 years earlier than average — mostly from preventable physical illness. What monitoring you are entitled to in Germany and the UK.
The mortality gap is the least discussed fact in psychiatry. The World Health Organization puts the reduction in life expectancy for people with severe mental disorders at 10 to 20 years, and the leading causes are not suicide but cardiovascular disease, diabetes, respiratory illness and cancer detected late.
Several forces stack up. Some antipsychotics drive weight gain and metabolic change. Smoking rates are far higher. Symptoms make appointments harder to keep. And diagnostic overshadowing — the tendency of clinicians to read new physical symptoms as part of the psychiatric picture — delays investigation of real illness.
This is why routine monitoring is not optional extra care. Weight and waist circumference, blood pressure, fasting glucose or HbA1c, and a lipid panel should be checked at baseline when an antipsychotic is started, again after roughly three months, and at least annually after that. An ECG matters for medications that affect cardiac conduction, and lithium requires regular lithium level, kidney and thyroid checks.
In the UK, people on the serious mental illness register are entitled to an annual physical health check through their GP practice, and NICE sets out the parameters. In Germany, monitoring sits with the treating psychiatrist or the Institutsambulanz, with the Hausarzt coordinating; the statutory Gesundheitsuntersuchung (check-up) is available from age 35 every three years, and from 18 once, and is worth using deliberately rather than incidentally.
Practical version: keep one sheet of paper or a phone note with your last values and dates. Bring it to every appointment. If a new physical symptom is dismissed, ask directly for it to be recorded in your notes that you requested investigation — that single sentence changes how requests are handled.
None of this is about blaming individuals for their weight or smoking. It is about a system that treats the mind and the body in separate buildings, and about the specific checks that close the gap.