I read with interest the report by McCreadie (Reference McCreadie2003), which concludes that the lifestyle of people with schizophrenia must give cause for concern in relation to coronary heart disease. Despite being at an increased risk of developing various physical health problems, the detection rate and treatment of physical illness among people with mental illness is very poor (Reference Koran, Sox and MartonKoran et al, 1989). The reasons why this vulnerable group of patients do not receive the physical health care they deserve are manifold and need to be addressed. They range from physical symptoms being misinterpreted as part of psychiatric illness by professionals, to poor social skills, lack of motivation, cognitive impairment and social isolation occurring as part of mental illness making individuals with schizophrenia less likely to report symptoms and adhere to treatment. When they do present themselves, their lack of social skills and the stigma of mental illness may also make it less likely that they receive good care (Reference Phelan, Stradins and MorrisonPhelan et al, 2001).

Services focusing on lifestyle changes geared to the particular needs of people with severe mental illness should be planned. Periodic medical reviews by general practitioners using essential checklists should be mandatory. Inability to clearly appreciate or describe a medical problem, compounded by a reluctance to discuss such problems, contributes to the lack of attention to medical problems in patients with schizophrenia. Thorough, routine physical examination whenever a patient is seen is the best way forward but it is doubtful whether psychiatric services have the resources and time to implement this. It is necessary for a medical orientation on the part of psychiatrists while evaluating all patients. Refresher training should be regularly provided for psychiatrists and key members of multidisciplinary community psychiatric teams. This could encompass elements of detection, management and preventive counselling (Reference Lambert, Velakoulis and PantelisLambert et al, 2003). To ensure appropriate care for comorbid medical problems there should be active efforts on the part of general practitioners as well as mental health teams.