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Findings The men spoken to had been struggling for years with poor mental health and suicidal thoughts and feelings. Despite experiencing many well-known risk factors for this group, many opportunities to help them at critical points before they reached crisis were missed. Importantly, the men spoken to didn't see community-based support services, focused on fostering connection and community, as relevant to them before they reached crisis. "There exists a vacuum of responsibility in which opportunities to engage and support these men, before they hit crisis point, were neglected." What is wanted from support services Among other things, the following were all key: The opportunity to make a contribution. A feeling of inclusivity. The chance to work towards common goals. Peer support and feeling like they had shared experience with other people.

The report makes a number of recommendations of how the needs of people who self-harm can be met more effectively: Government should ensure that planned investment in mental health support through the Long Term Plan results in specialist mental health services such as Improving Access to Psychological Therapies (IAPT) being supported with additional resource to increase expertise and capacity to support people who self-harm. NHS England should work with third sector experts and people with lived experience to develop a free self-care app for anyone who has presented to clinical services having self-harmed. GPs should be given more training to support them to deal with people who have self-harmed in a trauma informed way as well as being better informed about the types of care that can be effective in supporting people who self-harm. Department of Health and Social Care (DHSC) and DCMS should provide voluntary and community-based organisations with funding so they can provide a more consistent alternative to NHS support for people who self-harm.

Key findings 281 nurses who died by suicide were identified over the six-year study period; of these 204 (73%) were female – these were the main focus of the study. Female nurses were older than other women who died by suicide; nearly half were aged 45-54 years. The most common method of suicide for female nurses was self-poisoning (42%). • More than half (60%) of female nurses who died were not in contact with mental health services. 102 nurses who died were identified as patients; of these, 81 (79%) were female and their clinical histories were examined further. Their age distribution was similar to that of nurses in the general population who die by suicide, 40% being aged 45-54 years. Female nurses who were patients were similar to female patients in other occupations. The main primary diagnoses were affective disorders (59%), followed by personality disorders (19%). Overall 41% had a history of alcohol misuse and 20% reported a history of drug misuse. Nearly two-thirds of female nurses had a history of self-harm (64%). Self-poisoning accounted for 48% of the deaths by female nurses. The main drugs taken were psychotropics (33%), opiates (31%), and paracetamol (19%). Although prevalence of experiencing adverse life events within three months of death was similar across the groups, female nurses were reported to have more workplace problems (18%). There were few differences in the care received by the female nurses and by women in other occupations, though it was less common for nurses to have had a previous short psychiatric admission of seven days or fewer, and they were more often prescribed SSRIs/SNRIs.

I was experiencing symptoms of Covid-19 and when I became unable to complete a sentence or walk to the bathroom, my GP advised me to go to hospital. I have mental health difficulties and one of the staff recognised me from when I had been admitted previously, following a suicide attempt. I felt that I was treated like a 'frequent flyer' of A&E and that my symptoms were taken less seriously than they would have been otherwise. I was sent home after my tests for Covid came back negative and was told that it was just anxiety. I got much worse over the coming days. If I had tested negative, why was I feeling desperately unwell with all the published symptoms of Covid? I thought that I should be physically active if I didn't have Covid-19, so I pushed myself and berated myself when I repeatedly became unable to breath with a pounding heart upon any exertion. I couldn't cope caring for my four children and was in a 'critical' dangerous mental state many times. I self-harmed to try and cut off from feeling so awful. My physical health deteriorated. The ambulance was called by the GP who had sent a nurse to assess my oxygen levels and the paramedic said I should be in a coma according to my obs. This made me feel less like I was making it up, but it was still in my head despite my husband telling me repeatedly that the results of the test are 30% wrong. The paramedic gave me oxygen and I protested strongly against going to hospital a second time. The paramedic insisted I went, put me on oxygen and reassured me he would ask the hospital staff to relate to me as a patient who was showing clear signs of Covid and that I did struggle with my mental health but that I was doing my best to recover. I also asked the paramedics to inform the hospital staff about my eating disorder so they could gently help me to manage my low blood sugar without judgements and causing me further shame. In the hospital I saw a Dr who confirmed that I did have Covid-19 and that my test must have been a 'false negative'. I had felt judged, dismissed and had doubted myself. The first thing anyone I spoke to asked was whether or not I had had a test and whether it was positive. The negative test result isolated me from calling family and greeting neighbours as I didn't have the energy to go into the false negative answer. I found that saying my test was 'negative' sparked a surge of invalidation of everything I was experiencing. The isolation caused me further significant harm to my mental health. Among other fleeting symptoms I have had overwhelming fatigue, breathlessness, sweats or chills, no smell or taste, a rash, headaches and low mood. After nearly four weeks I am slowly recovering. I am lucky to have a social worker, family support worker and psychologist available over the phone through this period, so I do feel my family and I are supported. But I am interested to know if anyone else has found their symptoms are being quickly dismissed as anxiety when they are sure they have the virus? Or if anyone else feels like they haven't had their symptoms taken as seriously because of their mental health difficulties?