The study has clearly identified that among people with SMI in Ireland, a significant proportion are identified as having serious physical health conditions including cardiovascular, respiratory and diabetes related disorders and of those a considerable proportion require palliative care. Almost half of GPs (47%), and 56.3% of psychiatrists surveyed agreed that patients with a diagnosed SMI were less likely to have their palliative care needs identified compared to patients without a mental illness. Respondents also overwhelmingly agreed (Psychiatrists 90%; GPs 82%) that people with SMI are more likely to have physical health conditions overlooked than other patients. What is evident from this study is that people with SMI are disadvantaged as they are less likely to raise concerns about their physical health needs, to have health needs identified, or to access or to be offered palliative care. Findings from this study also portrayed the physical health care system as resistant to accepting people with SMI into the acute services. Interviewed participants identified the complex nature of managing co-morbid physical health issues. Requiring teams to engage in multi-agency and cross disciplinary collaboration. However, an absence of existing and/or underdeveloped structures within the Irish health care system to support such collaboration was identified as a barrier to the implementation of best practice evidenced based knowledge. To reduce existing health disparities currently impacting the lives of people with SMI and their families. This study recommends interventions at system level: policy, service planning and community levels, rather than focusing exclusively at the level of the individual.