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.
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".
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.
Cydney Yeates of the Daily Star and Duncan Lindsay of the Metro agreed that it was "one of [Holby City's] most emotional episodes to date".
[2][3] Lindsay's colleague, Sue Haasler, also enjoyed the episode, calling it "a powerful hour of television" with excellent performances from the core cast.
[4] 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.
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.
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.
[5][6] 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.
[6] 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".
[2] 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.
[2] The charity placed people with experience of mental health problems in contact with the show so that writers could develop scripts.
[2] Harper was thankful for Mind's help with the storyline,[2] while guest actor Luke Higgins tweeted that he was "proud" to work alongside the charity for the story.
[10] Barrett noted that through storylines such as Sacha's depression, Holby City has displayed an ability to give issue-led stories "justice".
[7] 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.
[11] "Brilliant writer Michelle Lipton shines a light on the vital issue of male mental health and how it can slip under the radar because of the reluctance of many men like Sacha who avoid seeking help for fear of appearing weak.
"[13] The show's executive producer, Simon Harper, described the episode as "incredibly important" and praised Barrett's performance, calling it "absolutely heart-breaking".
"[18] During the scenes set in previous episodes, a relationship between Sacha and teenage patient Connor Barrat (Luke Higgins) is established.
[6] Quarshie blamed Ric's lack of empathy on the "old school ethos" that Sacha should be a professional and carry on with his job, which he thought was well observed by Lipton.
[9] To capture this, Rooney decided that rather than using the traditional Steadicam, they would use a camera on a gimbal, which would allow the cameraperson to follow Barrett around the roof freely.
[7] Barrett wore a harness and rope, which was attached to Paul, the stunt coordinator, who ensured he would not fall during the scenes filmed on the edge of the roof.
[7] He compared the atmosphere to that during the filming of the eighteenth series episode "I'll Walk You Home", which features the death of a regular character.
[7] After the broadcast of the episode, a five-minute behind-the-scenes video was released on the show's website, featuring an interview with Barrett and Rooney about "Man Down".
"Man Down" was submitted as their entry to the awards and although the drama did not win, judges praised the episode and the exploration of Sacha's mental health.
[25] Calli Kitson, writing for Digital Spy, praised the episode and opined that Barrett accurately portrays someone struggling with depression.
[27] "It was a powerful hour of television and an incredible piece of work from Bob Barrett, and hopefully it will underline that it’s always best to seek out help before things get too much.
[28] The reviewer also noted how aesthetically pleasing the episode appeared, comparing it to a feature film or headline dramas such as Line of Duty.
[4] In her extended review, Haasler also explained why it was important that Connor was portrayed to be "loveable" as it helps the audience understand why Sacha is so upset.