One essential area of concern is monitoring for metabolic and diabetes risk when prescribing Second Generation Antipsychotics (SGAs). It is well established that patients with SMI have increased cardiac and diabetes vulnerability, which can lead to premature death in many people living with SMI. A large part of this risk is accounted for by side effects from SGAs and requires monitoring, collaboration, and prevention. The risk of metabolic side effects is even greater for children and adolescents who are prescribed these medications. Research also shows that many children and adolescents are not monitored for these preventable and risky side effects. The same important metabolic risks can occur in adults and again, monitoring often falls short. It is important to understand who is monitoring and addressing these risks–between mental health prescriber and primary care physicians–to avoid critical data slipping through the cracks. Monitoring is in the job description of both the mental health provider and the primary care physician, even though the treatment of the condition (cardiac, diabetic, etc.) usually falls in the realm of the primary care physician. Coordination and collaboration between the entire treatment team–including the patient and the family–is essential for successful monitoring and the best patient outcomes.