Health Beyond Symptoms: A Qualitative Study on Perceptions and Meanings of Health and Health Promotion among Individuals with Serious Mental Illness in Community Mental Health Settings

Individuals with serious mental illnesses (SMI) face significant health disparities, also affecting physical health. While Community Mental Health (CMH) services primarily support mental recovery, their potential to address the physical health needs of this population remains insufficiently understood. In particular, little is known about how service users conceptualize health and evaluate support efforts - especially with regard to physical well-being. Gaining insight into these perspectives is essential for developing person-centered health promotion strategies that align with users' lived experiences and contribute to reducing persistent disparities. This qualitative study explored, how individuals with SMI understand health in everyday life, how they perceive the role of CMH professionals in supporting their health, and how they make sense of and respond to health promotion efforts - particularly those targeting physical well-being. Twenty-three qualitative interviews with users of CMH services in Germany were analyzed using a reconstructive, comparative approach that aimed to capture meaning-making processes embedded in everyday social practice. Participants expressed three distinct subjective health orientations: (a) agency-oriented, viewing health as the ability to shape one's life according to personal goals; (b) stability-oriented, emphasizing inner balance, emotional control, and predictability; and (c) functionality-oriented, focusing on the capacity to manage everyday tasks. These orientations were conceptually distinct and shaped participants' understanding of health, their attitudes toward CMH services, and their evaluation of health promotion. Health was understood as embedded in daily routines, relationships, and biographical experience. Psychological stability was seen as interconnected and essential for physical well-being. CMH professionals were seen as consistent and trusted partners who promote health through close, everyday relationships and hands-on support. Health promotion and support for physical health was strongly welcomed - if it was voluntary, respectful, and practically integrated into daily life. Health was defined not through symptoms, but as a lived, everyday experience shaped by stability, agency, and biographical context. Health promotion was broadly welcomed when it was voluntary, respectful, and practically embedded in daily life. Although CMH services are primarily focused on mental health, they offer a promising environment for addressing the physical health needs of individuals with SMI.