This chapter emphasises the importance of the physical health history to holistic psychiatric case assessment. It describes the general approach to this and sets this particularly in the context of patients with serious or severe mental illness. Such patients have substantially increased morbidity and mortality from physical causes compared to the general population, and this increased mortality has been clearly documented for nearly two hundred years. A practical, collaborative and optimistic multilevel approach to attempting to make a difference to these outcomes is described, concluding with fourteen broad, practical areas for achievable interventions.