Screenings if you have serious mental illness

The yearly physical health check

NICE says GPs should check the physical health of people with psychosis or schizophrenia at least once a year once care passes to primary care, focusing on problems that are common in this group, and should look for high blood pressure, abnormal lipid levels, obesity or risk of obesity, diabetes or risk of diabetes, and low activity as early as possible. (NICE CG178) For bipolar disorder, NICE says the check, done at least once a year, should include: (NICE CG185)

weight or BMI, diet, nutrition and level of physical activity
pulse and blood pressure
fasting blood sugar or HbA1c, and a blood lipid (cholesterol) profile
liver function
kidney and thyroid function and calcium levels, for people taking long-term lithium

NICE also says to monitor weight and heart and metabolic measures routinely in people with these conditions. (NICE CG178) (NICE CG185) See blood pressure readings: what they mean, A1c and blood sugar test results, cholesterol test results and liver function test results.

Checks when antipsychotic medicine is started

NICE CG178 lists checks to record before antipsychotic medicine is started, including weight, waist size, pulse and blood pressure, fasting blood sugar or HbA1c, and blood lipids. It then sets a schedule for these checks during treatment: (NICE CG178)

weight weekly for the first 6 weeks, then at 12 weeks, at 1 year and then once a year
waist size once a year
pulse and blood pressure at 12 weeks, at 1 year and then once a year
fasting blood sugar or HbA1c, and blood lipids, at 12 weeks, at 1 year and then once a year

NICE says the mental health team keeps responsibility for this for at least the first 12 months or until the condition is stable, whichever is longer. (NICE CG178) The American Diabetes Association (ADA) recommends that people prescribed second-generation antipsychotic medicines are screened for prediabetes and diabetes at the start, again 12 to 16 weeks after starting or sooner if needed, and then once a year, because these medicines raise the risk of type 2 diabetes, often along with weight gain and raised blood fats. (ADA, 2026) The NHS says antipsychotics can raise blood cholesterol, change blood sugar and make blood pressure higher or lower than usual, so these may need to be monitored. (NHS, schizophrenia) See screenings if you have diabetes and screenings if you have overweight or obesity.

Heart risk scores

NICE says to use the QRISK3 tool to estimate 10-year heart and stroke risk for people aged 25 to 84 without heart disease. For people with severe mental illness, or who take atypical antipsychotics, it says to use QRISK3 rather than QRISK2, because QRISK2 does not count these and may underestimate risk. It also lists people with severe mental illness among the groups whose risk the tools may underestimate. (NICE NG238) The usual schedule is on cholesterol test by age and heart screenings by age.

Cancer screening

The bodies cited on this page do not set a different cancer screening schedule for people with serious mental illness, so the usual age-based schedule applies. A Public Health England report found that people with severe mental illness in England were 18% more likely not to have taken part in breast screening, 20% more likely not to have taken part in cervical screening and 31% more likely not to have taken part in bowel screening within the recommended time than people without it. For cervical screening, the gap was seen in the 45 to 64 age group. (PHE, 2021) The 2026 review found two trials in which case management helped people with SMI get physical health checks and cancer screening. (BJGP, 2026) The usual schedule is on cancer screenings by age; see also mammogram: what to expect, Pap smear: what to expect and colorectal cancer screening tests compared.

Mental health screening

Screening questionnaires for depression, anxiety and other conditions in the general population are covered on mental health screenings by age and depression screening: what to expect. If you smoke, see screenings if you smoke.

When to contact a provider

MedlinePlus, schizophrenia, when to contact a medical professional: (MedlinePlus, schizophrenia)

Contact your provider if you (or a family member):

Hear voices telling you to hurt yourself or others
Have the urge to hurt yourself or others
Feel scared or overwhelmed
See or hear things that are not there
Feel that you cannot leave the house
Feel that you are not able to care for yourself

If you are thinking about hurting yourself or others, call or text 988 or chat 988lifeline.org. You can also call 1-800-273-8255 (1-800-273-TALK). The 988 Suicide and Crisis Lifeline provides free and confidential support 24/7, anytime day or night.

You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.

If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.

MedlinePlus, bipolar disorder, when to contact a medical professional: (MedlinePlus, bipolar)

Seek help right away if you:

Have symptoms of mania
Feel the urge to hurt yourself or others
Feel hopeless, scared, or overwhelmed
See or hear things that are not there
Feel you cannot leave the house
Are not able to care for yourself

Contact your treating provider if:

Your symptoms are getting worse.
You have side effects from medicines.
You are not taking medicine the right way.

You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.

If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.

Where they differ:

What sets the blood sugar schedule. NICE ties a yearly blood sugar check to the condition itself, for schizophrenia and bipolar disorder alike, (NICE CG178) (NICE CG185) while the ADA ties its schedule to being prescribed a second-generation antipsychotic medicine. (ADA, 2026)
The first recheck. NICE sets it at 12 weeks after antipsychotic medicine is started, then at 1 year; (NICE CG178) the ADA says 12 to 16 weeks, or sooner if needed, then once a year. (ADA, 2026)
Liver tests. NICE's yearly check for bipolar disorder includes liver function; (NICE CG185) its list of checks for schizophrenia does not. (NICE CG178)

Your doctor decides what your result means for you.

Questions people ask

What is in the yearly physical health check for bipolar disorder?

NICE says the check, done at least once a year, should include weight or BMI, diet, nutrition and activity level; pulse and blood pressure; fasting blood sugar or HbA1c and a blood lipid profile; and liver function, with kidney, thyroid and calcium tests for people taking long-term lithium. (NICE CG185)

Who does the physical health check for schizophrenia?

NICE says the mental health team should monitor physical health for at least the first 12 months or until the condition is stable, and that GPs should then monitor it at least once a year once responsibility passes to primary care. (NICE CG178)

Is blood sugar checked more often with antipsychotic medicine?

The ADA recommends that people prescribed second-generation antipsychotic medicines are screened for prediabetes and diabetes at the start, again 12 to 16 weeks after starting or sooner if needed, and then once a year. (ADA, 2026)

Does serious mental illness change how heart risk is worked out?

NICE says to use the QRISK3 tool for people with severe mental illness, because QRISK2 does not take it into account and may underestimate 10-year risk. It also says risk tools may underestimate risk in people with severe mental illness. (NICE NG238)

Are cancer screenings different with serious mental illness?

The bodies cited here do not set a different cancer screening schedule. Public Health England found that people with severe mental illness in England were less likely to have taken part in bowel, breast and cervical screening than people without it. (PHE, 2021)