Improving the care of people with psychosis and other severe mental illnesses

Incidence of physical multimorbidity

First, the accumulation of physical health conditions in people with severe mental illness is addressed by Halstead et al. (2026) using a retrospective cohort design. By focusing on incidence rather than prevalence, the study provides information on the development of physical multimorbidity over time in psychiatric inpatients.

Compared with individuals without severe mental illness, those with schizophrenia spectrum or bipolar disorders had higher incidence rates across multiple thresholds of multimorbidity, affecting most organ systems (Halstead et al., 2026). These findings reinforce existing evidence that physical health disparities in this population extend beyond individual conditions and involve cumulative disease burden.

Oral health as a neglected area

Building on this work, Wheeler et al. (2026) explore the specific issue of oral health in this population using a mixed methods design. Their analysis indicates that oral health is rarely prioritised in mental health policy and receives minimal research funding. Qualitative data highlight important financial, psychological and systemic barriers to dental care, alongside a perception that oral health receives low priority within mental health services (Wheeler et al., 2026).

The study draws attention to the contribution of oral health to quality of life and hospital admissions. While the qualitative findings cannot be generalised, they raise questions about the extent to which routinely neglected health domains contribute to broader health inequities.

Physical health assessment in psychosis

Given the importance of physical and psychiatric comorbidity, it is important that there are agreed procedures to ensure adequate assessment. Warren et al. (2026) address variability in physical health assessment practices through a scoping review to identify physical conditions that may present with psychosis, as well as a systematic review of international guidelines for the assessment of physical health. The authors identified 84 physical health disorders in this category, although most were rare and typically accompanied by additional neurological or systemic features (Warren et al., 2026). In a review of 25 guidelines, the authors identified substantial heterogeneity in recommended investigations such as neuroimaging and autoimmune screening. However, there was consensus around metabolic screening.

On this basis, the authors propose a staged and individualised approach to investigation, guided primarily by clinical assessment. This approach reflects the balance between diagnostic thoroughness and the risk of unnecessary testing in routine practice.

Exercise interventions in psychiatric rehabilitation

One possible intervention is encouraging physical activity. The randomised controlled trial by Korman et al. (2025) contributes to the growing literature on physical activity interventions in people with psychotic disorders. Comparing resistance training with aerobic interval training in a rehabilitation setting, the authors report comparable feasibility, acceptability and safety between the two modalities (Korman et al., 2025).

Resistance training was associated with improvements in muscle strength and increased self-reported physical activity, although no between-group differences were observed in psychiatric symptoms or global functioning. The study is notable for its pragmatic focus on implementation within existing services. While the findings support the inclusion of resistance training as an option in rehabilitation programmes, they also underline the need for larger and long-term trials to determine clinical significance beyond physical fitness outcomes.

Non-restrictive management of aggression

Aggression in psychotic disorders remains a significant concern in acute and rehabilitation settings, given its association with patient harm, staff injury and the use of restrictive practices. Bulut and Yildirim (2026) review non-restrictive approaches to aggression management, synthesising evidence from 17 studies of varying design and quality. The interventions assessed span risk assessment tools, cognitive and social skills interventions, environmental strategies, staff training and multicomponent programmes.

A consistent finding across the reviewed studies was that multicomponent interventions were more likely to demonstrate effectiveness than isolated strategies (Bulut and Yildirim, 2026). Interventions involving staff training in de-escalation and patient-focused cognitive or social skills approaches showed moderate to high levels of evidence. The authors also highlight methodological limitations within the literature, including heterogeneity in outcomes and limited long-term follow-up, which constrains definitive conclusions regarding sustainability.

Trauma, shame and suicidal outcomes

Davies et al. (2026) examine the associations between trauma exposure, shame and suicidal behaviours in a tertiary psychosis service cohort. Trauma exposure was universal in the sample, with a substantial proportion related to psychosis symptoms or treatment experiences. Lifespan trauma exposure was associated with lifetime suicide attempts, whereas internal and external shame were more strongly associated with current suicidal ideation (Davies et al., 2026). The distinction between correlates of suicidal behaviour and ideation is therefore clinically relevant, suggesting that different mechanisms may underlie these outcomes.

Research participation and consent

Finally, the research letter by Arnautovska et al. (2025) focuses on research engagement rather than clinical care, describing a participatory approach to developing consent materials for people with lived experience of schizophrenia. The co-designed Participant Information and Consent Forms improved accessibility and comprehension (Arnautovska et al., 2025). Although limited in scope, the work illustrates methodological considerations relevant to conducting research with populations experiencing cognitive and motivational impairments.