Under-recognitions of somatic illnesses have frequently been suggested to explain the well-known increased risks of mortality in long-stay psychiatric patients. There are, however, no studies, in which register information on realized somatic hospitalisations and mortality from somatic illnesses in psychiatric patients are actually linked and simultaneously evaluated. In this study, 208 long-stay psychiatric patients, suffering from functional psychoses (mainly schizophrenia) in Northern Finland were followed up for 11 years, and screened for all somatic hospitalisations and subsequent causes of death. 86.5% of the patients had undergone hospital treatment due to some physical illness after their first psychiatric admission. During specialized psychiatric care the majority of the deceased patients had received some somatic treatment for illnesses that ultimately caused their deaths: 81% representing circulatory, 71% digestive, 56% neoplastic, and 36% respiratory ailments. We found no evidence for the frequently expressed view that somatic illnesses in psychiatric patients were under-recognized. Thus, the widely-documented poor physical outcome of long-stay psychiatric patients may be not attributable to neglect of care or abandon, but to difficulties in efficaciously addressing medical conditions in a population characterised by unhealthy life-style habits, psychiatric disability and isolation. The health care systems apparently offer a range of services, but the latter do not always reach the patients. Why this is so requires detailed further investigation.