BACKGROUND AND OBJECTIVES: The physical health of people with serious mental illness is a cause of growing concern to clinicians. Life expectancy in this population may be reduced by up to 25 years and patients often live with considerable physical morbidity that can dramatically reduce quality of life and contribute to social exclusion. This study sought to determine whether the serious mental illness health improvement profile [HIP], facilitated by mental health nurses [MHNs], has the clinical potential to identify physical morbidity and inform future evidence-based care. DESIGN: Retrospective documentation audit and qualitative evaluation of patients' and clinicians' views about the use of the HIP in practice. SETTING: A nurse-led outpatient medication management clinic, for community adult patients with serious mental illness in Scotland. PARTICIPANTS: 31 Community patients with serious mental illness seen in the clinic by 2 MHNs trained to use the HIP. All 31 patients, 9 MHNs, 4 consultant psychiatrists and 12 general practitioners [GPs] (primary care physicians) participated in the qualitative evaluation. METHODS: A retrospective documentation audit of case notes for all patients where the HIP had been implemented. Semi-structured interviews with patients and their secondary care clinicians. Postal survey of GPs. RESULTS: 189 Physical health issues were identified (mean 6.1 per patient). Items most frequently flagged 'red', suggesting that intervention was required, were body mass index [BMI] (n=24), breast self-examination (n=23), waist circumference (n=21), pulse (n=14) and diet (n=13). Some rates of physical health problems observed were broadly similar to those reported in studies of patients receiving antipsychotics in primary care but much lower than those reported in epidemiological studies. Individualised care was planned and delivered with each patient based on the profile. 28 discreet interventions that included providing advice, promoting health behavioural change, performing an electrocardiogram and making a referral to professional colleagues were used. Qualitative feedback was positive. Our observations support the use of the HIP in clinical settings to enhance mental health nursing practice; however, we strongly recommend that training is required to support the use of the HIP.