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  This study focuses on people with severe mental illness (SMI) which includes problems like bipolar affective disorder, psychosis and other long-term problems that severely impact on daily activities. It is recognised that people with SMI also have problems with their physical health such as heart, breathing problems, diabetes, and cancers; however, less attention has been paid to sexual health. Like everyone else, positive sexual relationships are important for people with SMI but this is rarely discussed in routine mental health care. Therefore, they can be unaware of important information such as where to get sexual health advice, how to reduce risk of sexually transmitted infections; contraceptive choices and finding relationships that are mutually respectful not violent or abusive. We are a team of researchers, doctors, nurses, and people with mental health lived experience who got funding from the National Institute for Health Research (NIHR) to carry out the RESPECT study. In the study, we worked with people with lived experience and those who work in sexual health to develop a 3 session support package that helped 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 support package in a feasibility study (which is done to check whether people with SMI would want to join the study (recruitment) and stay in the study (retention). Our lived experience researchers interviewed participants over the phone and found that participants reported that the study felt safe, comfortable, convenient and useful. We were able recruit enough people, and able to keep people in the study until the end (retention), and there was 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. This proposal builds on our earlier study and asks whether the support package will improve sexual health outcomes for people with SMI compared with those who don’t receive it. We will recruit 400 people with SMI (which should be enough numbers to be sure about our results) from community mental health teams from 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 or not. A local mental health worker will deliver the support package group for 3 x one-hour sessions to those allocated to it. Information will be collected at 3, 6 and 12 months after recruitment. Those who were allocated to the support package will be compared with those who were not, to see if the support package improves sexual health. We will also do interviews with a small group of participants to find out how they found the support package and 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. We will work with NHS care providers, commissioners of healthcare, and people with lived experience of SMI to ensure that sexual health becomes part of routine care in mental health services