People who have severe mental illness are nearly five times more likely to die from acute physical disease before the age of 75, a new review has found.
The report, which calls for urgent national action, showed that adults living with severe mental illness (SMI) in England face persistent health inequalities, with previous data showing they die on average 15 to 20 years earlier than their peers.
Carried out by Rethink Mental Illness, the Closing the Mortality Gap report analysed NHS data of patients aged 18–74 who were in contact with secondary mental health services in the five years before their death between 2022 and 2024.¹
In total, 129,216 people with SMI died in this period. The stark findings showed that overall, the excess mortality for adults with SMI in this time frame was 379%, meaning they were 4.8 times more likely to die under the age of 75 than those without SMI.
Cancer, cardiovascular disease (CVD), liver disease and respiratory disease accounted for over half of these deaths (56%). Specifically, before the age of 75, people living with a mental illness were 6.3 times as likely to die from liver disease, six times more likely to die from respiratory disease, 3.8 times more likely to die from CVD and 2.25 times more likely to die from cancer.
Cancer accounted for 18.8% of deaths, cardiovascular disease for 18.7%, respiratory disease for 10.9%, and liver disease for 8.1%.
Further analysis showed that those with SMI were more likely to develop chronic conditions such as higher body weight, asthma, diabetes, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), stroke, heart failure and liver disease at a younger age than the general population.
For working-age adults living with mental illness, deaths from CVD and cancer during the reporting period were the highest they have ever been, accounting for more than 24,000 deaths each during this period.
In a supplementary report, suicide was found to account for 6.9% of all deaths in the mental health population, making people with mental health issues 14.6 times more likely to die by suicide compared to their non-SMI peers.²
The report cites a number of reasons why people with severe mental illness are more likely to develop and die from physical illness, including that they may turn to food as a source of comfort, have lower levels of physical activity, smoke cigarettes or misuse drugs or alcohol.
The study found that compared to 13% of the general population, 40% of those with SMI are smokers and often do so in order to alleviate symptoms of their condition. Around 50% of deaths in those with SMI are attributed to smoking.
People with SMI aged 15 to 74 were almost twice as likely to have a higher body weight than their general population counterparts, contributing to the risk of CVD, Type 2 diabetes and certain cancers, while antipsychotic medicines can often cause rapid and significant weight gain.
Additionally, people experiencing SMI may also struggle to seek and receive the care that they need, underscored by a lack of integration of physical and mental healthcare within the NHS.
Diagnostic overshadowing was also referenced as a factor, which happens when a person’s physical health symptoms are mistaken for symptoms of their existing mental health conditions and, therefore, not investigated further.
Compounding these challenges, people with severe mental health conditions are much more likely to live in poverty, which can also limit their ability to afford healthy food and access healthcare, and increase their levels of stress.
Despite the stark figures presented in this report and previous evidence to suggest the link between severe mental illness and increased mortality, the authors of the report suggest that action to address the “crisis” has “not gone far enough”.¹
They make several recommendations to healthcare providers and policymakers, including advising the implementation of integrated physical and mental healthcare for tailored, person-centred support.
A comprehensive, cross-governmental plan for mental health should address key drivers of poor physical and mental health, particularly in high-risk groups such as young people, those on antipsychotic medications, and inpatients.
The report also encourages a shift from reactive to preventative approaches and a focus on stopping people from smoking, maintaining a healthy weight and doing frequent physical activity.
This includes increasing health spending on services that ensure sustainable, habit-forming lifestyle support for patients struggling to implement these changes in their lives.
The report also calls for all services commissioned for people with SMI to be co-produced with those who have lived experience of mental illness, ensuring that care is tailored to their needs. It recommends that services employ staff trained in both mental and physical health conditions and work collaboratively with local organisations to improve access to community-based care and address existing inequalities.
Additionally, the authors call for a long-term mental health workforce strategy to improve the recruitment, training and retention of healthcare professionals, ensuring they are equipped to recognise and manage physical health needs alongside mental health conditions.
This would include expanding training opportunities, improving working conditions and pay, and embedding peer support roles across services.
Mark Winstanley, chief executive of Rethink Mental Illness, said: “It is a scandal that people living with severe mental health problems are so much more likely than the rest of the population to die from often preventable physical health conditions. This new data also highlights the urgent need to strengthen suicide prevention, with too many people in contact with mental health services still losing their lives to suicide.
“Given that many are in frequent contact with health services throughout their lives, it is clear that opportunities to identify and treat physical health problems are being missed.”
He continued: “We must remember that these early deaths are not inevitable. Physical health checks are an essential part of care for people living with severe mental illness. The next step is to ensure everyone receives one, and that problems identified lead to people receiving the support they need to improve their health.”
“People living with severe mental illness need joined-up care that considers both mental and physical health, or their lives will continue to be cut short… We need to see a real shift towards prevention in healthcare to stop people from becoming so mentally and physically unwell in the first place,” he added.
References
1 Rethink Mental Illness. Closing the Mortality Gap: Tackling health inequalities experienced by those living with severe mental illness. 2026. https://rethink.org/media/s0uht1y5/closing-the-mortality-gap.pdf
2 Office for Health Improvement & Disparities. Suicide in people with severe mental health problems: report. Department of Health and Social Care. 2026. https://www.gov.uk/government/statistics/suicide-in-people-with-severe-mental-health-problems/suicide-in-people-with-severe-mental-health-problems-report#introduction
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