Easier Said Than Done

Rethinking lifestyle interventions in mental health care, together.

Marianne would like to thank Anastasia Goula and Yuri Milaneschi (Amsterdam UMC) for generously sharing their expertise in appraising and discussing the latest scientific literature, and members of the ImmunoMIND Co-production Council for their invaluable critical review of this piece from the perspective of persons with lived experience.

Photo by Hannah Busing from Unsplash

Lifestyle advice has become almost inseparable from conversations about mental health. Open a newspaper, scroll through social media, or visit a health website, and the message is strikingly consistent: exercise regularly, eat well, sleep properly, reduce alcohol, stay connected. These recommendations are usually well-intentioned and evidence-based. Yet for people living with severe mental illness (SMI), they can feel strangely out of reach.

I am a medical doctor who worked on co-production (explained later) within ImmunoMIND, one of the research hubs composing the Mental Health Platform, the UKRI-funded network aimed at accelerating research on SMI. Working shoulder-to-shoulder clinicians, researchers, and people with lived experience, gave me the opportunity to reflect on how feasible standard lifestyle advice truly is in the context of mental health.

For instance, on the NHS webpages, including self-help guides and tools for mental health, it is indicated that “To stay healthy, adults should do 150 minutes of moderate-intensity activity every week”. Targets like this may be motivating for some, but for others, they can feel like a quiet rebuke -especially when symptoms such as fatigue, hypersomnia (that is, excessive daytime sleepiness), low motivation, cognitive slowing, or medication side effects are central features of the illness itself.

The implicit assumption is that behaviour change is simply a matter of choice or effort, when in reality, the illness can directly undermine the abilities required to act on that advice.

There can also be a mismatch between recommendations and reality. Media articles may suggest asking a GP about exercise on prescription or social prescribing, but this assumes time, confidence, and access. This gap becomes even more visible in healthcare settings. In practice, appointments are short, services are often stretched, and many people may hesitate to raise anything that does not feel urgent enough. As a result, lifestyle support can end up framed as optional, or as something to come back to later, once things are “better”.

Something that can go unacknowledged is how contradictory this can feel to a person with SMI. Being advised to be more active when motivation is low, to socialise when anxiety is high, or to improve sleep while medication disrupts it can feel disheartening rather than empowering. When advice does not openly recognise these tensions, it risks sounding simplistic, even if the evidence behind it is strong.

Bridging this disconnect requires not abandoning lifestyle interventions, but rethinking how they are framed, delivered, and personalised for those living with more complex and enduring mental health conditions.

Image from sketchplanations.com

What Does Research Tell Us About Lifestyle Interventions for Serious Mental Illnesses?

Patients with SMI are twice as likely to suffer from physical health problems, such as cardiovascular disease, contributing to a higher risk of premature death. The good news is that lifestyle interventions can make a real difference. Today, their benefits are well established for both mental and physical health, particularly in four key areas: physical activity, nutrition, quitting smoking, and sleep.

With ample research supporting the effectiveness of lifestyle interventions, the latest report of the Lancet Psychiatry Physical Health Commission - an international panel of researchers, clinicians and health experts also connecting to groups of individuals with lived experience - emphasises the need to also focus on implementation research. That is, understanding how such interventions can be best delivered and integrated as core clinical practice while acknowledging the social and financial nuances. The report discussed that these interventions can and should be offered across all settings, including inpatient, outpatient, and community contexts, and at any stage of the illness.

Notably, introducing lifestyle changes as early as possible is crucial for two main reasons.

First, it can help prevent physical health problems, which often arise either from long-lasting, untreated mental illness or from the chronic side effects of medications.

Second, early intervention can help overcome the barriers that often make it difficult for people with SMI to engage with and stick to these programs. These barriers include physical or somatic symptoms, such as low energy or cognitive difficulties, as well as psychological factors like low motivation or lack of confidence.

Admittedly, as mentioned before, the suggested interventions often seem counter-intuitive or particularly challenging for patients, mainly because of the conflicting nature of the disease and the intervention. For instance, engaging in regular physical activity when energy and motivation levels are low, participating in group programs when social anxiety is high, or reducing smoking when it serves as a primary means of social connection can all feel overwhelming. These challenges highlight the importance of tailoring interventions and providing structured support, ensuring that lifestyle changes are both achievable and sustainable for people with SMI.

Co-production: bringing research results into real lives

If lifestyle interventions are to benefit people with SMI, the future must lie not only in what we recommend, but in how knowledge is generated, communicated, and implemented.

Over the past decade, research has firmly established that interventions targeting physical activity, nutrition, sleep, and smoking can improve both mental and physical health outcomes in SMI. The challenge now is no longer proving that these interventions work in principle, but understanding how they can work in real lives.

This is where patient-centred research and co-production become essential rather than optional. Co-production means involving people with lived experience at every stage, from study design to dissemination and striving to work in equal partnership.

Too often, research questions are shaped without meaningful input from those most affected, resulting in interventions that are theoretically sound but practically misaligned. Co-production helps ensure that research reflects real priorities, real barriers, and real definitions of success. Importantly, to realise the full potential of co-production, it is crucial to involve a diverse range of people with lived experience, reflecting different backgrounds, contexts, and perspectives.

Photo by krakenimages from Unsplash

Co-production is a key pillar we are developing in ImmunoMIND, where we established a council bringing together researchers, clinicians, and people with lived experience across several projects. One of these projects explores lifestyle changes that could be more effective and accessible for people living with SMI. 

Combining the complementary experiences and perspectives in the collective work of co-production councils can challenge hidden biases and assumptions about motivation, capacity, and engagement related to lifestyle changes in SMI. Co-production councils can help reframe lifestyle interventions not as moral imperatives or performance targets, but as flexible tools that can be adapted to fluctuating symptoms, social contexts, and personal values.

Equally important is how research is communicated. Public understanding of lifestyle and mental health is often shaped by simplified headlines or one-size-fits-all messaging. Involving people with lived experience in translating research findings can make guidance more nuanced, compassionate, and credible. It also helps counter the misunderstood narrative that recovery depends on ‘willpower’.

Looking ahead, the future of lifestyle interventions in SMI depends on this shift. Fewer prescriptions, more collaboration. Less assumption, more listening.

Co-production does not dilute the science. It grounds it, making it far more likely to matter.