Background: Severe mental illness is linked to poor physical health and shorter life expectancy. Most research focuses on mental health professionals’ views to improve physical health of those with mental illness. However, little is known about mental health service users’ perspectives and their perceptions of their physical health. Objectives: This research study aimed to examine mental health service users’ perceptions of their physical health, including challenges to and enablers to health improving strategies. Moreover, the study investigated mental health service users’ experiences, views on general practice care and preferences for suitable health care delivery. Participants: The participants were mental health service users who were engaging with Mental Health and Addictions services of the Waikato district. Study participants consisted of survey participants (n = 167), and interviewees (n = 6). While three Māori and three non-Māori service users participated in the interview, Māori and Pacifica (n= 54) and non-Māori (n = 82) contributed to the survey. Methods: The mixed method study involved two phases. Phase I gathered quantitative data from an online Qualtrics survey, measuring participants’ quality of life using the 12-item Short Form (SF-12) survey, and determining their demographics and preferences relating their physical health. The primary outcome measures of the survey were the SF-12 (determining self-assessed physical and mental health), in correlation with questions relating physical health, and demographics. Statistically significant questions that arose from the survey, were explored in second phase. Phase II collected qualitative data using semi-structured interviews with mental health service users. The qualitative data analysis used an inductive approach. Results: The quantitative data analysis involved a parsimonious modelling approach that included two general linear modelling analyses of covariance (ANCOVA). The analysis revealed statistical significance between the participants’ SF-12 PCS and ethnicity (p = 0.043), time in mental health service (p = 0.005), contact with general practitioner (p = 0.001), and mental health and addiction medication (p = 0.05). In addition, participants SF-12 showed statistical significance between participants’ physical component score (PCS) and between the combination of ethnicity, age, and gender (p = 0.041). Moreover, the analysis highlighted an additional link between participants’ mental component score (MCS) and their preference to improve their physical health (p = 0.038). The key findings of the free-text responses of the survey revealed four key themes including accessibility and availability, people want to be healthy, staff attitude, and medication. The results of the interviews revealed three main themes including physical health perception, the role of medication, and the importance of the relationship with the GP. Conclusion: Mental health service users perceive their physical health as an interconnected construct of health. They have complex physical health experiences and require a collaborative approach from primary and secondary care services. In addition, they have a desire to improve their physical health, however, face barriers such as diagnostic overshadowing, side effects of psychotropic medication and poor accessibility. Staff in general practices and mental health professionals should be mindful of these barriers and are required to provide individualised holistic care tailored to the preferences and needs of people with severe mental illness.