Lifestyle interventions must become a core part of mental health care

Australians living with severe mental illness continue to die around 15 years earlier than the general population. The majority of this gap is driven not by suicide but by preventable physical health conditions such as heart disease and diabetes.

As our new Lancet Psychiatry Physical Health Commission Report highlights, these conditions are tightly linked to modifiable behaviours — high smoking rates, poor diet, low physical activity, and disrupted sleep. These behaviours are not simply “lifestyle choices” but are deeply shaped by social and economic inequities: economic hardship, food insecurity, stigma, and fragmented health services.

The evidence is clear. Lifestyle interventions — programs that support people to quit smoking, improve diet quality, increase physical activity, and restore healthy sleep — when delivered in a way that meets the needs of people living with mental illness, can reduce psychiatric symptoms, improve physical health, and extend life expectancy. The task before us is no longer to prove efficacy, but to embed these interventions into the core of mental health care.

What works?

Our Commission reviewed 18 meta-analyses and nearly 100 intervention studies. The findings are quite striking:

• Successful programs include co-design with people who have lived experience, flexible delivery including telehealth and peer-led options, and attention to equity.
• Prevention-focused initiatives often showed stronger effects and are especially important given the side-effects of psychotropic, particularly antipsychotic, medications.
• Initiatives delivered by specialist practitioners were most effective, however, in their absence, sharing responsibility for delivering lifestyle interventions across all staff, such as peer workers and community health workers, was also effective.

Why do we need to improve?

Despite decades of evidence, the reach of these lifestyle programs remains limited. Our synthesis identified familiar barriers:

• Entrenched practices: lifestyle interventions are often viewed and resourced as “nice to have” rather than core clinical practice.
• Workforce constraints: inadequate employment of lifestyle focused practitioners and integration into mental health teams.
• Short-term funding cycles: many pilot projects emerge but collapse once grant funding ends.
• Equity blind spots: most studies come from high-income countries, with limited applicability to culturally diverse and limited resource settings.

Lessons from Australia

Australia has been at the forefront of implementing and evaluating novel innovations. Programs such as Keeping the Body in Mind and Keep Quitting in Mind (a community-based nutrition and exercise, and smoking cessation initiatives) and Healthy Bodies, Healthy Minds (a gym-based program co-delivered by dietitians, exercise physiologists, and peer workers) demonstrate what is possible when services are co-designed, embedded in routine care, and sustained by cross-sector partnerships. A more recent initiative — Addi Moves — seeks to embed initiatives upstream within a community-based organisation. However, these programs remain the exception rather than the norm. 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

Our Commission outlines 18 priorities to bridge the evidence–implementation gap, spanning the micro (clinical), meso (service), and macro (policy) levels. Some of the most urgent include:

• Embedding lifestyle interventions into clinical guidelines and commissioning frameworks.
• Investing in a specialist workforce, including dietitians and exercise physiologists, within mental health services.
• Expanding peer roles, to support to implementation and sustainment of interventions.
• Ensuring interventions are equity-focused, adapted for Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse groups, and people living in low-resource settings.
• Establishing long-term funding mechanisms that move beyond pilot projects to sustainable services.

The time is now

The physical health inequities faced by people with mental illness are not inevitable — they are the product of systemic inaction. We would not accept a 15-year mortality gap for any other population group in Australia.

Lifestyle interventions are not an optional “add-on” to psychiatric care. They are evidence-based, cost-effective, and life-saving. With the right investment and commitment, we can close one of the greatest equity gaps in Australian health.

Listen to our discussion with the editor of the Lancet Psychiatry about our commission for free here.

Scott Teasdale is a dietitian and NHMRC Emerging Leader who co-leads the Nutrition, Exercise and Social Equity (NExuS) research group within the Discipline of Psychiatry & Mental Health, UNSW Sydney. He is lead author of the Lancet Psychiatry Physical Health Commission Third Report on Implementing Lifestyle Interventions in Mental Health Care.

Simon Rosenbaum is an exercise physiologist and NHMRC Emerging Leader who co-leads the Nutrition, Exercise and Social Equity (NExuS) research group within the Discipline of Psychiatry & Mental Health, UNSW Sydney. He is co-senior author of the Lancet Psychiatry Physical Health Commission Third Report on Implementing Lifestyle Interventions in Mental Health Care.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

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