<p>Disparate rates of cardiovascular disease (CVD) contribute to the shortened life expectancy of people with serious mental illness (SMI). CVD and its risk factors, including obesity, hypertension, diabetes and dyslipidemia, often arise in young adulthood, but there is a paucity of research focusing on emerging and young adults. This study describes the health characteristics of emerging (ages 16–24) and young (ages 25–39) adults with SMI upon enrollment into a community mental health (CMH)-based integrated primary and mental health care program (<i>n</i> = 439). Data were collected via structured interviews, biometric assessments and medical record review. Biometric assessments indicated that 54% had obesity, 46% had hypertension, 5% had diabetes and 6% had LDL-C hyperlipidemia. Proportions with CVD risk factors did not significantly differ between emerging and young adults. When compared to the general population, this group of emerging and young adults with SMI had higher rates of obesity, hypertension and diabetes. Very few participants with CVD risk factors had corresponding diagnoses recorded in their CMH medical records. Most participants with CVD risk were not receiving behavioral or pharmacotherapy-based interventions for their physical health conditions – among participants with blood pressure over 140/90, 56% were receiving no intervention, 33% were receiving pharmacotherapy, 13% were participating in behavioral intervention. This study highlights the need for screening and treatment of CVD risk factors in emerging and young adults with SMI. Mental health center-based integrated care programs and certified community behavioral health clinics (CCBHCs) may provide the means to increase access and quality of physical health care among young people with SMI.</p>