Background People living with severe mental illness (SMI) are over three times more likely to have a physical health condition as cardiovascular diseases and diabetes, and die on average 15–20 years earlier, than others in the general population. This is largely due to preventable medical conditions, supporting the need for more holistic and multidisciplinary preventative health support approaches for people with multiple complex needs. Although effective services exist, implementation is mixed and engagement relatively poor. Here, we used a lens provided by the Consolidated Framework for Implementation Research (CFIR) to critique the current delivery landscape in one region of England, aiming to identify factors that might influence intervention implementation and future service planning.

Methods Qualitative data were collected using semi-structured interviews, workshops, and focus groups with stakeholders, comprising experts by experience (n=21; people living with SMI and/or carers and close family members) and those in professional roles relating to supporting people living with SMI (n = 14). These were analysed alongside secondary sources (e.g., policy documents) using an interpretive description (ID) approach.

Results Networks and communication were experienced as fragmented, with difficulties in accessing knowledge on services, exacerbated by a perceived lack of resources. Cultural separation between physical and mental health services was experienced, though there was widespread engagement in the need for innovation in this area. Settings’ openness and networking with external organisations was highly valued. Participants advocated for more blurred lines: in eligibility criteria, in how services could be accessed, and in the ways in which healthcare and community providers collaborate to support service delivery.

Conclusion Successful implementation of holistic health support for people living with SMI is likely to require innovative service models to enable resource and information sharing across provider settings. Encouragingly, there is buy-in and appetite for innovation for moving towards truly holistic healthcare for people living with SMI; stakeholders will need to become comfortable working across ‘blurred lines’.