Abstract
BACKGROUND: Food insecurity (FI) is a pressing issue for adults with Severe Mental Illness (SMI), with evidence showing a higher prevalence in this group compared to the general population. However, routine screening for FI in adults with SMI within healthcare settings is currently lacking. Research has indicated that lack of access to adequate food may affect medication adherence and overall health outcomes in this population. This study explored how FI screening can be integrated into routine healthcare practices, co-produced with individuals with lived experience of SMI, in order to improve early identification, enhance acceptability, and support implementation within mental health services. METHODS: A mixed-methods exploratory study was conducted between April and June 2025 within one NHS mental health Trust in North East England. Semi-structured interviews were undertaken with peer-support workers with lived experience of SMI (n = 4), and an anonymous online survey was completed by mental health professionals across disciplines (n = 40). Interview data were analysed thematically, and survey data were analysed using descriptive statistics and content analysis of open-text responses. RESULTS: Peer-support workers identified missed opportunities in healthcare where FI could have been addressed, and expressed preferences for flexible, non-stigmatising screening methods. Barriers included time constraints, stigma, and lack of training, while solutions focused on embedding screening within care planning and leveraging trusted relationships. Survey findings showed that most professionals acknowledged the importance of FI screening, especially during initial assessments and routine care. However, only 33% reported routinely screening for FI. Participants supported short, compassionate screening tools and highlighted the need for training, validated tools, and referral pathways. DISCUSSION: Findings highlight the urgent need to normalise FI screening as a routine aspect of mental healthcare. Both professionals and peer workers highlighted that FI impacts mental and physical health and recovery. Flexible tools and relationally delivered screening, especially by peer workers, nurses, and community teams, were seen as most acceptable.