Second-generation antipsychotics are highly effective in controlling symptoms if taken as prescribed. However, poor medication adherence results in patients continuing to experience psychotic episodes and metabolic disturbances that can cause them to develop abnormal lipid levels, weight gain, and diabetes. Understanding the underlying modulators that impact follow-up appointments and metabolic monitoring is critical. Semi-structured interviews were conducted with patients and their treating psychiatrists across four sites in South India. Narrative data were thematically analyzed, informed by an inductive approach. Patient-reported barriers included medication side effects, lack of awareness about metabolic monitoring, and financial constraints. Psychiatrists reported both patient and resource barriers that impact their provision of care. This study has shed light on key barriers impacting the provision of care and subsequently health outcomes for patients living with severe mental illness to inform strategies that target barriers for both patients and psychiatrists.