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Like everyone else, positive and fulfilling sexual relationships are important for people with severe mental illness (SMI) but this is a topic that’s rarely discussed in routine mental health care.

Therefore, people with SMI lack important knowledge such as where to get sexual health advice, how to reduce the risk of sexually transmitted infections, contraceptive choices, and finding relationships that are mutually respectful, not violent or abusive.

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Previous Work

Before running the moreRESPECT study we carried out a small feasibility study called RESPECT. In that study, we worked with people with lived experience of SMI and those who work in sexual health to develop a 3 session intervention which was a guided conversation and exercises designed to help people with SMI to think about their own sexual health, and provided useful information about how to improve their sexual health. We then evaluated the intervention to check whether people with SMI would want to join the study (recruitment) and stay in the study (retention). We interviewed participants over the phone and found that participants reported that the study felt safe, comfortable, convenient and useful. We were able to recruit people, people stayed in the study until the end (retention), and there was also good attendance at the support package sessions. There were no issues of people becoming distressed or more unwell because of taking part in the study.

Current Study

The moreRESPECT study builds on our earlier small feasibility study, RESPECT, and asks whether the 3 session intervention will improve sexual health outcomes for people with SMI compared with those who don’t receive it. We hope to recruit 400 people with SMI (which should be enough numbers to be sure about our results) from community mental health teams working in NHS mental health services across England and Scotland over 24 months. Information (data) will be collected about their sexual health, and they will be randomly allocated either to usual care or to receive usual care plus the support package. Random allocation (a bit like tossing a coin heads or tails) means an equal chance to receive the support package intervention plus usual care or continue with their usual care only.

The Intervention

A local mental health worker (such as a peer worker, support worker, or nurse), who has received appropriate training, will deliver the intervention in 3 sessions. Each session will last about one hour. This will be delivered as an online meeting or, if required, as a face-to-face meeting. Wherever it is delivered, privacy will be assured. The 3 sessions will include discussions about sexually transmitted infections, ways to prevent infections (such as using condoms), information about contraception, where to seek advice and help in relation to sexual health and staying safe in intimate relationships. This is suitable to anyone irrespective of their relationship status, gender and/or sexual orientation.
Usual care

People who are randomised to the usual care group will continue to receive the care and support that is usually available to them. No additional care or treatment will be given to them as part of the study. This will allow us to find out whether the sexual information sessions are useful in addition to usual care.

Everyone who takes part in the study will receive a sheet listing local sexual and reproductive health services and some condoms irrespective of whether they are in control or intervention group.

Data Collection

Information (data) is collected at the start of the study which includes a set of questionnaires and an interview about sexual behaviours. This is repeated at 3,6, 9, and 12 months. This information will allow us to see whether there is any difference between those who had the intervention compared to those who did not have it, across a range of things such as reducing unprotected sex acts, increasing safer sexual practices (e.g., using condoms), increases access to sexual health services, and motivation to adopt safer sexual practices.


We also hope to interview a small group of participants to find out how they found the study, whether it worked better for some than others, and in what circumstances. This will help make decisions about the best ways for this to be included in routine care if it is shown to be successful.