Australians living with severe mental illness face a stark reality: they die approximately 15 years earlier than the general population. This alarming statistic is not primarily due to suicide but rather preventable physical health conditions such as heart disease and diabetes. These conditions are intricately linked to modifiable behaviors, according to the latest Lancet Psychiatry Physical Health Commission Report.
The report highlights that high smoking rates, poor diet, low physical activity, and disrupted sleep are not merely “lifestyle choices” but are deeply influenced by social and economic inequities, including economic hardship, food insecurity, stigma, and fragmented health services. The evidence is unequivocal: lifestyle interventions can significantly reduce psychiatric symptoms, improve physical health, and extend life expectancy when tailored to the needs of those living with mental illness.
Understanding Effective Interventions
The Commission’s review of 18 meta-analyses and nearly 100 intervention studies reveals striking findings about what works in lifestyle interventions. Successful programs often involve co-design with individuals who have lived experience, flexible delivery options such as telehealth and peer-led initiatives, and a focus on equity.
“Prevention-focused initiatives often showed stronger effects and are especially important given the side-effects of psychotropic, particularly antipsychotic, medications.”
Specialist practitioners delivering these interventions were most effective, yet in their absence, distributing responsibility across all staff, including peer and community health workers, proved beneficial.
Barriers to Widespread Implementation
Despite decades of evidence supporting lifestyle interventions, their reach remains limited. Several barriers persist, including entrenched practices that view these interventions as supplementary rather than essential, workforce constraints, and short-term funding cycles that often see pilot projects collapse once initial funding ends.
Additionally, there are significant equity blind spots. Most studies originate from high-income countries, limiting their applicability to culturally diverse and resource-limited settings.
Lessons from Australia
Australia has been a leader in implementing and evaluating innovative programs. Initiatives like Keeping the Body in Mind and Keep Quitting in Mind demonstrate the potential of co-designed, community-based nutrition and exercise programs. The more recent Addi Moves initiative aims to embed these interventions upstream within community organizations.
“Most mental health services still lack systematic referral pathways for physical health support. Lifestyle screening is patchy, and too often clinicians are left without time, training, or tools to intervene.”
A Roadmap for Change
The Commission outlines 18 priorities to bridge the evidence–implementation gap, addressing clinical, service, and policy levels. Key priorities include embedding lifestyle interventions into clinical guidelines, investing in a specialist workforce, expanding peer roles, and ensuring interventions are equity-focused.
“Establishing long-term funding mechanisms that move beyond pilot projects to sustainable services is crucial.”
The Urgency of Now
The physical health inequities faced by those with mental illness are not inevitable; they are the result of systemic inaction. As Scott Teasdale, a lead author of the report, emphasizes, lifestyle interventions are evidence-based, cost-effective, and life-saving. With the right investment and commitment, Australia can close one of the greatest equity gaps in its health system.
Scott Teasdale and Simon Rosenbaum, both NHMRC Emerging Leaders, co-lead the Nutrition, Exercise and Social Equity (NExuS) research group within the Discipline of Psychiatry & Mental Health at UNSW Sydney. Their work underscores the urgent need to integrate lifestyle interventions into mental health care.
