© 2015 National Rural Health Alliance Inc.Objective: There is an increased risk of physical health comorbidities in people with a mental illness. This paper examines the metabolic syndrome parameters for the general population, indigenous Australians and people with a mental illness, and compares them to a sample of predominantly indigenous adults with mental health problems. Design: A longitudinal (24 month) audit of patient medical records was conducted between February 2011 and March 2013. Setting: The Kimberley Mental Health and Drug Service in Broome, Western Australia. Participants: Largely indigenous adults with a mental illness. Sample numbers increased from 56 at baseline (80% indigenous) to 136 at 18 months (70% indigenous). Main outcome measures: Waist circumference, blood pressure, fasting lipids, and fasting blood glucose. Results: Preliminary assessment of the data indicates a high percentage of abnormalities at baseline and at the 18 month period on all four parameters, yet not all patients were assessed on a regular basis. Conclusions: Abnormalities in metabolic profiles consistent with the non-Indigenous mental health population were found. There are considerable challenges to implementing regular monitoring of physical and metabolic profiles of indigenous people in rural and remote communities.