Negotiating Physical Health: Professional Logics in Community Mental Health Practice

Individuals with serious mental illness (SMI) face profound and largely preventable physical health inequities shaped by social and structural conditions, representing a major public health concern related to avoidable health inequalities. Because many receive everyday support in community mental health (CMH) systems, these services represent a crucial arena for understanding how such inequities are encountered and made sense of in practice. The study examines how physical health is understood within German CMH practice. Five group discussions with 30 CMH workers were analysed using an interpretive qualitative approach. The analysis identified five professional logics through which physical health becomes part of CMH support: trusting relationships that both enable and limit action; psychological stability as a core mandate; physical health positioned between recognition and delegation; fragile motivation combined with an ethics of restraint; and health promotion situated between aspiration and structural constraint. The findings show that helping relationships, everyday environments, and organisational structures create specific conditions for health-related support. Strengthening these interconnected levels may enable CMH to integrate physical health more systematically, offering insights relevant to international CMH contexts facing similar relational and structural challenges.