Severe mental illness is associated with increased risk of premature death due to chronic somatic diseases. Patients with severe mental illness receive less medical care regarding these problems, than others, and that it is not well defined with whom the responsibility of treating their physical health problems lies.

There is a need for lifestyle interventions and focus on physical health in patients with severe mental illness. The patients' and staff perspective upon the problems and possibilities of change is important.

To investigate physical health problems and their causes as well as possibilities for preventing and treating them, as experienced by the staff and patients.

Focus Group Discussions with patients and staff respectively, from three out-patient clinics treating patients with schizophrenia or substance use disorder comorbid to another psychiatric disorder.

The paramount physical health problems are weight issues, cardiovascular diseases and bad physical shape in general. The main causes are lifestyle, the mental disorder and organisational issues. Possibilities for prevention and treatment includes: a case-manger, binding communities with like-minded. Furthermore less fragmentation of the treatment system and implementation of focus upon physical health into daily practice in psychiatry.

To prevent and treat physical health problems in patients with severe mental illness, support in daily structure and lifestyle changes is needed. There is a need for a change in clinical practice and implementation of routines regarding physical health, supported by the managements.