Serious mental illness, particularly psychosis, exemplified by schizophrenia is associated with a significant decrease of life expectancy of up to 25- 30 years.  The decrease in life expectancy has occurred in the face of improvements in life expectancy in the general population. This decrease is due predominantly to the enhanced development of cardiovascular disease, diabetes and obesity.  Traditionally the increase in metabolic disease has been attributed to the use of atypical antipsychotics. By a variety of mechanisms, these drugs may aggravate derangements in glucose and lipid metabolism and lead to weight increases.  However, prior to the introduction of these “atypicals”, metabolic disease was noted to be more pronounced and common in those with schizophrenia.    Drug independent factors such as the illness itself and poor diet and lifestyle are likely to play a greater role in the genesis of the enhanced cardiovascular risk.  Traditional cardiovascular risk factors are prominent.  Up to 80-85% of patients smoke.  Hypertension and dyslipidaemia, the latter characterized particularly by low HDL levels, are common. In addition, patients with schizophrenia have abnormal sleep patterns, sleep quality and sleep duration. These disruptions to circadian rhythms are also likely to play a significant role in the increase in weight and metabolic risk.  Only a minority of these patients has a primary health care practitioner and even a smaller proportion seek medical advice on a regular basis. Sadly, there is little evidence that traditional cardiovascular risk factors are identified or addressed appropriately. More tragic is the absence of any coordinated national or state approach to improving the health of this marginalized group.