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Purpose. To examine practices, barriers, and recommendations for addressing the physical health of racially and ethnically diverse people with serious mental illness (SMI). Methods. Semi-structured interviews and participant observations were conducted with 21 administrators and 25 clinicians representing six mental health care organizations. Data were analyzed using constant comparative methods. Results. Practices included intermittently collecting consumers’ physical health data, connecting consumers with primary care, and providing on-site, culturally-tailored health promotion programs. Barriers included limited care coordination infrastructure, financial and professional boundaries, unhealthy local environments and culturally-specific dietary habits. Recommendations included: strengthening dialogue with medical providers and developing staff training programs. Conclusion. Meeting the physical health needs of diverse consumers with SMI is impeded by organizational, environmental, and consumer-level barriers. Establishing better care coordination networks, increasing mental health provider education on medical issues, and culturally-tailoring health promotion programming provide plausible strategies for improving the physical health of this vulnerable population.