Mental health services must urgently increase investment in lifestyle interventions to improve care and help close the 15-year life expectancy gap faced by people with mental illness, a new Lancet Psychiatry Commission report warns.
Lifestyle interventions targeting physical activity, nutrition, sleep and smoking are key to mental health care, according to the report published today by a team of 30 authors from 19 countries.
“Our lifestyles can change the trajectory of our mental and physical health,” said lead author Dr Scott Teasdale, a dietitian and Senior Research Fellow with UNSW Sydney’s Discipline of Psychiatry and Mental Health and Mindgardens Neuroscience Network, opens in a new window.
“Many people living with mental health challenges face barriers to being physically active, eating a balanced and nutrient-rich diet, getting quality sleep, and quitting smoking. These, in turn, impact their mental health further and contribute to physical health disparities,” Dr Teasdale said.
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Making changes to these lifestyle risk factors is proven to ease symptoms and improve overall health and wellbeing, making it an important addition to psychological therapy and medication, he said. But people with mental illness need support to make these changes.
“This is not just about individual behaviour change, it’s about transforming systems to support health and wellbeing,” Dr Teasdale said.
A roadmap for reform
The Commission report, ‘Implementing lifestyle interventions in mental health care’, opens in a new window, sets out a roadmap for better integrating lifestyle interventions into mental health care systems worldwide – from bringing in exercise and nutrition specialists to shifting workforce attitudes to prioritise a holistic approach.
It builds on a 2019 Commission report on protecting physical health in people with mental illness – who die 13 to 15 years earlier than the general population, largely due to preventable conditions such as cardiovascular disease and diabetes.
The researchers reviewed 89 recent lifestyle interventions – targeting physical activity, nutrition, smoking and sleep – and 18 meta-analyses to determine the most effective approaches.
This resulted in eight recommendations and 19 priorities for action, reviewed by people with lived experience and a Global South Advisory Group – 14 experts from lower income or conflict-affected countries – to ensure they could be adapted across diverse settings.
The report is one of two published by The Lancet Psychiatry Physical Health Commission on Wednesday, with the other, led by the University of Queensland, focused on the prevention and management of physical health side effects of medication.
Common principles, local solutions
Increased funding, upskilling of mental health staff and enabling access to a broader range of allied health professionals will be key to better incorporating lifestyle interventions into mental health care.
“Mental health services have traditionally focused on medications, crisis care and therapy, and lifestyle hadn’t been prioritised — in funding, training or service delivery,” Dr Teasdale said. “We previously didn’t have the evidence on the benefits of lifestyle changes, but that’s no longer the case.”
While delivery methods must be tailored to local contexts, many of the core principles are universal, said senior author Professor Simon Rosenbaum, also from UNSW’s Discipline of Psychiatry and Mental Health.
“We’ve identified common elements that should apply to care, whether you’re in a refugee camp in Bangladesh or a hospital in Sydney’s eastern suburbs,” Prof. Rosenbaum said.
This includes creating psychologically safe environments and ensuring support staff have the empathy and skills to provide trauma-informed, culturally sensitive care.
“Embedding these interventions must be done in partnership with people who live with mental illness, and with attention to the social and economic realities they face,” Prof. Rosenbaum said.
“There are tangible steps we can take, from how we train future health professionals, to how we design and deliver care,” he said.
Professor Pillaveetil Sathyadas Indu from Kerala University of Health Sciences, and co-chair of the Global South Advisory Group, said the recommendations were adaptable across diverse settings, including her home country of India.
“In countries with limited resources, the focus may be on upskilling existing staff and non-specialist workers, and engaging family members, to help deliver lifestyle interventions,” Prof. Indu said.
Embedding exercise and nutrition specialists into services at top training and research institutions would also help drive systemic change, she said.
Shifting clinical practice in Australia
The shift toward lifestyle-focused care is already underway in Australia. Lifestyle changes, along with psychological interventions, were listed as foundational in the 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders, opens in a new window, with medication integrated as needed.
“They’ve flipped the model,” said Dr Teasdale. “An ideal treatment plan no longer starts and ends with medication and psychology support. It now begins with lifestyle changes and psychological support as the foundation, with medication added where needed.”
But change has been slow, amid budget constraints and an already stretched workforce, and more needs to be done by government, health services and education providers to enable lifestyle interventions to be better embedded in routine care.
While implementing lifestyle interventions will require greater upfront investment, the authors say it will pay off in the long run.
“Our biggest challenge is implementation. When lifestyle interventions are implemented effectively, they can be cost effective.” Dr Teasdale said. “That means a higher upfront investment in lifestyle interventions could reduce more substantial health care and societal costs in the long run.”
“Improving these lifestyle factors is crucial for the mental wellbeing of every person, and in the prevention and management of mental illness.”
Source: University of New South Wales
Published on August 18, 2025