As psychiatrists, we are responsible for large numbers of patients who require follow-up over years, and often lifelong. Usually these patients suffer from chronic psychotic illnesses, and their psychiatrist may be their main point of contact with the medical profession. As a group they face a whole range of problems – not only from the psychiatric condition itself, with its associated stigma and psychosocial stresses, but also from unemployment, poverty, poor housing and worse physical health.This review will look at the evidence that patients in continuing care have increased morbidity and mortality. The types of illness excess will be examined and explanations suggested as to why such an increase exists. Finally, we present practical steps that might usefully be taken to reduce physical illness and premature death in this vulnerable group.