After attempting to end her life at the same age as Evie’s mum, Linda Fisken set up a charity called Linda’s Ladies which provides support in the community for women experiencing mental health problems who need to talk. I won’t say anything more specifically about Karen and Natalie’s stories here as you can hear their family members speak in the programme. The producers supplied me with reports into their deaths and my comments are included, alongside statements from the mental health services whose care they were under, but for me there were some key lessons for services:

• Repeated and escalating severity of self-harm should be a red flag.
• Women’s distress, particularly when it is accompanied by self-harm, is simply not taken seriously enough. It’s far too easy to get the diagnosis of ‘Borderline or Emotionally Unstable Personality Disorder and for the severity of depression to be underestimated. I’ve also seen far too many women given this diagnosis (it’s 3 times more common than in men) when their depression isn’t lifting.
• We still underestimate the impact of hormones on women’s mental health. A history of post-natal depression should flag up the likelihood of an increase in mood problems at the time of the menopause. The mean age of the menopause is 50 years. The peak suicide rate for women in England is between the ages of 50 and 54.
• We’ve lost many of the women’s centres that provided support and a place to talk and share, and that link women up with practical help.
• Lastly, it’s far too easy to get lost in the system when moving between one team and another. When you are severely depressed you may not think you deserve help. We cannot expect someone to engage and self-advocate when they are feeling they have lost hope and are exhausted by repeated refusal. Continuity of care not only allows us to build relationships, but ensures that there are people, be it GP or mental health worker, who knows who we are and what we are like when we are well.

When young women self-harm they aren’t seen as asking for help in the right way. The same can be said of older women too. They aren’t behaving how patients, especially women patients, ought to behave but it isn’t clear how they should behave to be taken seriously.

In the recent paper on self-harm on women in mid-life from the multicentre study of self-harm in England it was reported that women in mid-life (age 40-59) more often used self-poisoning alone as the main method of self-harm compared to younger women and were more likely to receive a specialist psychosocial assessment. Alcohol was also more likely to be involved and they were more often currently receiving psychiatric care, although these differences were small. We need much more research on self-harm and suicide in women to reduce the gender health gap and as Professor Nav Kapur said at the recent launch of the NCISH 2025 report, ‘menopause/perimenopause and suicide risk is an emerging and important area of research.’

The emphasis over the last two decades on men’s unmet needs has been understandable because of their much higher suicide rate, but we also need to shift and widen the focus to consider what is happening to women too.

Women’s mental health needs are still misunderstood, misdiagnosed and underserved due to entrenched gender biases in medicine, societal pressures and inadequate support systems.