"Man Down" is the thirty-fifth episode of the twentieth series of the British medical drama television series Holby City, and the 938th episode of the overall series. The episode was written by Michelle Lipton and directed by Tracey Rooney, and premiered on BBC One on 28 August 2018. The plot sees Sacha Levy (Bob Barrett), who has depression, contemplate suicide on the roof of Holby City Hospital after the death of long-term patient Connor Barrat (Luke Higgins), with whom he has bonded. The episode features flashbacks to scenes set at key moments within the previous year, which are portrayed from Sacha's perspective. Lipton reread scripts from the past year when developing the flashbacks.
The episode was announced on 10 August 2018, where the show's executive producer, Simon Harper, teased the exploration of a year in the mind of a "beloved, vulnerable character". The episode serves as a climax to a story exploring Sacha's mental health, which began in series 18 (2016). Barrett felt honoured to have a whole episode assigned to the story. Holby City worked with the British mental health charity Mind to accurately portray the story and Barrett researched the subject further, speaking to friends and medical professionals with mental health issues and those who have attempted suicide.
Filming for the episode took place at the BBC Elstree Centre studios and involved filming on the rooftop across two days. To showcase Sacha's agitation on the roof, Rooney opted to use a camera on a gimbal rather than a traditional Steadicam, which Barrett felt benefited his performance. For Sacha's suicidal scenes, Barrett had to walk onto the edge of the roof using only a harness and rope; he chose to perform his own stunts rather than use a stuntman. The actor suffers from vertigo and was initially scared about filming on the roof, but he channelled his fears into his acting.
"Man Down" was promoted through a series of trailers and cast members being interviewed on television. The episode received a positive response from television critics. Cydney Yeates of the Daily Star and Duncan Lindsay of the Metro agreed that it was "one of [Holby City] most emotional episodes to date". Lindsay's colleague, Sue Haasler, also enjoyed the episode, calling it "a powerful hour of television" with excellent performances from the core cast. The episode was submitted as the show's entry at the 2019 Broadcast Awards, where judges praised Rooney's direction and Lipton's character development.
Plot Sacha Levy (Bob Barrett) and Ric Griffin (Hugh Quarshie), consultants in general surgery, are operating on Connor Barrat (Luke Higgins), who has Crohn's disease, when he suffers a haemorrhage and cannot be resuscitated. Sacha goes to the roof of the hospital, closely followed by Ric, who tries comforting Sacha. Flashbacks from the past year depict a close bond developing between Sacha and Connor. In the present day, Sacha admits to Ric that he was depressed,As depicted in the series 19 episode "Two Hearts". but Ric struggles to understand its relevance to Connor. Flashbacks show Sacha meeting Connor and his parents, Ruth Barrat (Madeleine Bowyer) and Martin Barrat (Gary Finan), and a dejected Sacha finding Connor vomiting.As depicted in the series 19 episode "It Has to Be Now". After admitting Connor to hospital, they discuss their relationships. In the present day, Ric berates Sacha for using Connor as emotional support and states that he is still depressed, which Sacha angrily denies. As Ric reminds Sacha of his importance at the hospital, Sacha remembers when his friends did not need him.As depicted in the series 19 episodes "Group Animal" and series 20 episode "Ready or Not". Sacha tells Ric that Connor was the only person who has needed him.
In a flashback, Connor supports Sacha following the hospital shooting.As depicted in the series 19 episodes "Group Animal". In the present day, Ric questions Sacha and Connor's relationship, before comparing himself to Sacha. Flashbacks show Connor helping Sacha impress Patricia Ghraoui (Sirine Saba).As depicted in the series 20 episodes "Only a Word" and "The Friend Zone". Sacha confronts Ric about his research project, triggering a flashback where he is belittled.As depicted in the series 20 episode "Belonging". Ric warns Sacha to "man up", so Sacha leaves the roof and returns to Connor, where he performs shemira over Connor's body. Connor's friend, Tyler Saba (Hiran Abeysekera), who also has Crohn's, arrives and offers to continue the reading while Sacha speaks to Ruth and Martin.
Sacha fast-tracks Connor's post-mortem and as he watches the examination, flashbacks show the build-up to Connor's operation, ending with Ric announcing his death in theatre. Pathologist Helen Watton (Angela Yeoh) confirms that Sacha could not have changed the outcome. Alone, he breaks down in tears. After being thanked by Connor's parents, Sacha says goodbye to his friends. Consultant general surgeon Serena Campbell (Catherine Russell) tells Ric to apologise to Sacha. Sacha returns to the hospital roof and flashbacks of events from the past year depict his thoughts. Ric locates Sacha and talks him down from the edge; Sacha confides in Ric about his mental health. As Sacha leaves the hospital, Tyler asks him to become his consultant and operate on him. He explains that Sacha bettered Connor's life, so Sacha tentatively agrees following a break.
Production Background Holby City scripted a new storyline for character Sacha Levy (Bob Barrett) focusing on his mental health and male depression, which began in 2016 with the character's separation from Essie Harrison (Kaye Wragg). Across the storyline, Sacha's relationship with his family breaks down, his research project, which he invested money in, collapses, Essie is diagnosed with cancer and his friend Jac Naylor (Rosie Marcel) is shot. Barrett explained that Sacha feels "impotent" when he cannot help Essie and Jac. The actor told Sue Haasler, writing for the Metro, that Sacha believes that his woes are not as important as those of other characters who have suffered traumatic experiences, but also pointed out that every individual suffers in their own way.
Following the initial setup of the story, it was not prominently explored again for a while. Barrett thought that the audience would believe the story had been dropped but promised that it would be featured subtly. He explained that the writers wanted to portray Sacha as "pretending that everything's fine". Throughout the story, Sacha hides his depression from his friends and colleagues, which Barrett pointed out that he did well since he dislikes admitting his own problems.
Research Holby City worked with the British mental health charity Mind to accurately portray Sacha's depression and consulted them during the production of "Man Down". Jenni Regan, a media manager for the charity, was impressed with the show's portrayal of male mental health issues and thought it was a good choice to use the character of Sacha to do so. The charity placed people with experience of mental health problems in contact with the show so that writers could develop scripts. Harper was thankful for Mind's help with the storyline, while guest actor Luke Higgins tweeted that he was "proud" to work alongside the charity for the story. Barrett noted that through storylines such as Sacha's depression, Holby City has displayed an ability to give issue-led stories "justice". He wanted to use the show's large viewership to alter the opinion on mental illness and hoped that people suffering from depression would speak about their problems after watching the episode.
Having previously researched the subject for the storyline, Barrett performed a more detailed study into male depression and suicide for "Man Down", specifically about male mental illness within the medical profession. He spoke in detail with friends suffering from depression, which he felt was important for his portrayal, and also spoke with medical professionals who suffer from mental illness. The actor drew on experiences with friends who have attempted suicide, noting that "the worse it is, the more they have tried to hide it." The research allowed Barrett to gain a better personal understanding of depression and helped him think about the subject more. Barrett praised the decision to raise awareness for mental health and suicide in a male doctor. He commented, "it's especially frowned upon for a doctor to talk about suffering from depression because their job is to care for other people, so it's a really important story to tell." He told a reporter from The Sunday Post that medical professionals are scared of "self-doubt" and are good at keeping their emotions hidden.
Conception and development
On 10 August 2018, it was announced that Holby City would broadcast a special episode focusing on Sacha's depression. The episode features scenes from previous episodes that are portrayed from Sacha's mindset, allowing for a "haunting insight" into how Sacha is feeling. Rachel McGrath of the HuffPost called "Man Down" a complete change in format for the show. A BBC Online editor billed the episode as "a gripping episode of Holby City which takes you behind Sacha's smile and into his mind." The show's executive producer, Simon Harper, described the episode as "incredibly important" and praised Barrett's performance, calling it "absolutely heart-breaking". He added that the episode would follow "one troubled year in the life of one beloved, vulnerable character."
When producers informed Barrett about their plans to explore Sacha's depression story again in a stylised format, he did not realise that they were referring to a whole episode of the series being assigned to the story. He said that when he realised, he was "unbelievably touched". The episode was written by Michelle Lipton, directed by Tracey Rooney and produced by Irma Inniss. Lipton reread all the scripts from the episodes in the year-long storyline when creating the flashback scenes. The flashbacks were set at key moments across the year, including the death of Essie's husband, Raf di Lucca (Joe McFadden), and Jac's breakdown following her sister's death. Barrett explained that Sacha has struggled "privately" with these moments. The actor enjoyed the flashbacks and called Lipton "an amazing writer" who created "an incredible script". He added that Sacha's characterisation helps the episode to become "truthful". Harper also enjoyed the script, praising Lipton's writing. Rooney expressed on social networking site Twitter how proud she was about the episode. She described it as "tremendously powerful" and praised the performances of the core cast members. Barrett also expressed a sense of responsibility in ensuring the story was accurately portrayed.
Marcel confirmed in a May 2018 interview with Inside Soap that a main character would be killed off, although she did not confirm who it would be. Following a July 2018 episode, fans began to speculate that Sacha could be the character who dies when he kills himself. Duncan Lindsay of the Metro reported that the show would not confirm whether Sacha dies.