Introduction: People living with severe and persistent mental illness (SPMI) may experience high levels of psychological distress resulting from complexities with managing their mental health, co-existing physical conditions, medication regimens, stigma and social disconnection. Higher levels of psychological distress are associated with increased mortality; of particular concern for the SPMI population with higher risks of reduced life expectancy compared to the general population. Increased psychological distress may also indicate worsening SPMI. Aims and Objectives: To explore psychological distress levels using the Kessler (K6) scale and psychotropic medication management (focusing on polypharmacy and high-dose prescribing) in an adult cohort experiencing SPMI living in the Australian community between September 2020 and July 2021. Method: As part of a randomised controlled trial (RCT), community pharmacists recruited people living with SPMI taking antipsychotics or mood stabilisers from three Australian states/territories. Participants completed an electronic survey including the K6 and a medication review with a pharmacist who was asked to provide a distress report when participants recorded ‘very high’ (⩾19/30) K6 scores; a convenience sample of reports for the first 150 recruited participants was explored. All psychotropic medications were recorded and reviewed for alignment with clinical guidelines. Results: In total 326 participants recruited from 51 community pharmacies had baseline data for analysis: mean age 47 years, 53% female, 60% reported ⩾2 mental health conditions (predominantly moderate-severe mood (57%) and/or anxiety disorders (45%)), 45% ⩾2 physical health conditions, 22% a hospital admission in previous 6-months. Participants were prescribed an average of two psychotropic medications (range: 1–6); 84% ⩾1 antipsychotics, 69.5% ⩾1 antidepressants, 46% ⩾1 mood stabilisers, 18.5% 1–2 benzodiazepines. Polypharmacy within a medication group was recorded for less than 20% of participants; highest rates occurred with mood stabilisers (19%) and antipsychotics (18%). High-dose treatment was recorded for 19% of participants. At baseline, 25% of participants reported ‘high’ (14–18/30) and 34% ‘very high’ (⩾19/30) K6 scores. Amongst the first 150 participants, 59 reported ‘very high’ K6 scores, and although 25 exhibited signs of psychological distress, none indicated acute mental health crisis. Precipitating factors included family/personal circumstances, medicines changes/adverse effects, substance use. Discussion: Experiencing high/very high levels of psychological distress was common for more than half (59%) of this community-dwelling participant population. In comparison, the 2020–21 Australian National Study of Mental Health and Wellbeing found 15.4% of the general population reported high/very high levels.1 With recent research demonstrating increased mortality among those with high distress,2 there is a critical need to identify those at risk and reduce distress with tailored holistic healthcare. Overall, psychotropic prescribing did not diverge greatly in terms of polypharmacy and/or high dose prescribing compared to published literature. However, it highlights the importance of regular medication reviews and strengthened communications with consumers and prescribers in community mental healthcare settings. Conclusions: Community-based, pharmacist-led services are well placed to address medication-related problems and improve health and wellbeing and provide engagement opportunities to reduce distress, and hence, premature mortality for people living with SPMI.