By Shannon Fleming, MD

Poor Physical Health Outcomes in the Mentally Ill, and How to Help

Moving to the West Seventh neighborhood of Saint Paul last spring, my husband and I were thrilled to see a community of people who care- about each other, about their health, about their tiny libraries, and about the festival of the day. We saw artist’s lofts, thriving local businesses, friendships between diverse peoples, and green spaces everywhere- from community centers to parks to gardens. We saw Day by Day Café and Fresh Grounds Coffee, which not only serve delicious food and coffee, but also offer gainful employment to people recovering from addiction.

The United Family Medicine clinic is located at the heart of this neighborhood. There, we see many patients who are motivated to improve their health. Chronic conditions such as diabetes and high blood pressure continue to plague many, despite their best efforts. It is clear to me that difficulty in managing chronic medical conditions is more common among those who also have Serous Mental Illness (SMI), including depression, anxiety, schizophrenia, bipolar disorder, and PTSD. This is not an isolated problem.

What is Serious Mental Illness (SMI)? According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the definition is a moving target, but the federal government broadly states that it can include any mental illness that “resulted in serious functional impairment, which substantially interferes with or limits one or more major life activities such as maintaining interpersonal relationships, activities of daily living, self-care, employment, and recreation.”

Why is SMI related to worse health outcomes? In Minnesota, the average life expectancy for people with SMI is reduced by 24 years, mainly due to complications of obesity. Nationally, more than 80% of people with SMI are overweight or obese.

Is SMI a problem in our community? Yes, we see its effect on our clinic population daily, but the numbers also speak volumes. Ramsey County has more psychiatric admissions (11.3/1000 residents) than any other metropolitan county in Minnesota.

There are multiple contributing factors to the poor physical health of the mentally ill. Psychiatric medications can make it harder to lose weight, but there is much more to the story. Other factors include difficulty with “executive function”- ability to plan and manage the daily tasks of one’s life in a goal directed manner, and social determinants such as lack of access to medical care, lack of access to healthy food, lack of knowledge about nutrition, tobacco use, and sedentary lifestyle.

There has been one quite successful effort to combat this discouraging trend through group weight loss and wellness classes developed at Kaiser Permanente. It is called the STRIDE program and consists of group visits with a formal 6 month curriculum about nutrition, exercise, and mindful living, led by case managers and healthcare professionals such as physicians, dieticians, nurses, and physical therapists. It is an intensive program, with weekly 2 hour sessions. Each session includes a group walk, as well as interactive activities and check ins to see how participants are progressing toward their personal goals. Dr. Dane Nimako and I plan to implement this course at Radias Health in downtown Saint Paul, tentatively in January of 2018, in an effort to help motivated individuals with SMI in our own community reach their goals for healthier living.

Saint Paul is indeed a city of people who care. What else can we do reach out to some of our most stigmatized neighbors as they seek to improve their health? If you have a skill such as nutrition or exercise expertise, volunteer to teach at one of our sessions! Advocate to make bikes more accessible to those with SMI through a partnership like the one recently announced between HCMC and Nice Ride Minnesota. Donate nutritious food to food banks.

Have ideas? Want to help our efforts? Contact us at stridesquad@gmail.com to offer to help or to learn more.

For more information about the STRIDE program, serious mental illness, and Nice Ride’s partnership with HCMC, see the links below:




United Family Medicine

United Family Medicine