The Closing the Gap Health Study – Understanding modifiable health risk among people with severe mental ill-health


by Ben Lorimer

People with severe mental ill health (SMI), including those with schizophrenia spectrum disorders and bipolar disorder, die on average 15-20 years earlier than those in the general population. Avoidable risks, including lack of physical activity, poor diet, obesity, and smoking, have been identified as significant contributors to this health inequality. Improving our understanding of the prevalence and extent of these risk factors, and people’s willingness to modify them (where possible), will help to guide the development of strategies to reduce the impact of such factors and close the ‘health and mortality gap’.

The Closing the Gap (CtG) Health Study was established in response to these concerns regarding the poor physical health and mortality of people with SMI. In this study, 9914 adults with SMI completed a survey that asked questions related to demographics, general physical health, diet, physical activity, smoking, and Body Mass Index (BMI). Participants were recruited from 314 primary care sites and 23 secondary care sites across England between 2016 and 2020.

Among people with SMI, high rates of obesity (37.5%), infrequent physical activity (62.0%), smoking (42.2%) and not meeting current guidelines (5+) for the consumption of fruit and vegetables (85.0%) were observed. More findings from this study related to factors associated with low fruit and vegetable consumption among people with SMI can be found in Lorimer et al 2023. Despite the prevalence of these risk factors, most participants were motivated to reduce their engagement in these health risk behaviours. It was also identified that perceiving healthy living as important, being of poorer general health, and being female were significantly associated with being motivated to modify health risk behaviours.

This study’s findings suggest that although people with SMI engage in health risk behaviours at a higher level compared to the general population, they are just as likely to want to modify health risk to improve their health. However, we note that people with SMI often experience ‘therapeutic nihilism’ for behaviours such as smoking, meaning that effective interventions are not offered. There is clear evidence regarding ‘what works’ in managing behavioural risk factors, and the present study provides evidence of the willingness to engage in behavioural health programmes and indicates those populations where willingness to engage is highest.  


Peckham E, Lorimer B, Spanakis P, Heron P, Crosland S, Walker L et al (2023) Health risk behaviours among people with severe mental ill health: understanding modifiable risk in the Closing the Gap Health Study. British Journal of Psychiatry.  

Lorimer B, Traviss‑Turner G, Hill A, Baker S, Gilbody S, and Peckham E. (2023) Factors associated with low fruit and vegetable consumption among people with severe mental ill health. Social Psychiatry and Psychiatric Epidemiology.

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