Back in 2022 I saw a presentation by the Department of Health and Social Care about the Draft Mental Health Bill 2022. The first main slide said:
All ethnic groups have higher rates of detention per 100,000 population than White people. Black or Black British people are over four times more likely to be detained under the Act and ten times more likely to receive a CTO when compared with White people.
Detention rates in 2022/23 by ethnic group, from lowest to highest, were: Chinese (52 for every 100,000 people), Indian (55), white British (63), white (64), mixed white and Asian (69), white Irish (69), Pakistani (70), Asian (75), Bangladeshi (78), white other (86), mixed white and black Caribbean (102), other (107), Asian other (117), mixed white and black African (139), black African (158), mixed (158), other ethnic groups (171), black Caribbean (223), black (228), mixed other (288), black other (715). Detention rates for the five âotherâ categories may be overrepresented (and the non-âotherâ categories therefore underrepresented). Rates have been standardised for age.
There are various possible interpretations of the statistics: (1) the people are the same and the system is unfair; (2) the people are different and the system is fair; or (3) something on a sliding scale between those two extremes. It seems that the official view only considers the first possibility, and so blames the statute and the professionals working under it. Iâve just read an interesting article considering the second: Fiona Hamilton, âIs psychiatryâs focus on race stats linked to Nottingham attacks?â (The Times, 19 March 2026).
There are two things I find odd: that a government department would want to misconstrue something so complicated and nuanced as simply a âblack and whiteâ issue, and that policy seems to be based on only one interpretation of the statistics. Any ideas?
Interesting article here from the Telegraph. Itâs behind a paywall (or create an account for free for 7 days and then remember to cancel). Reading the Telegraph is my antidote to being in echo chambers. And sometimes it has interesting things like this:
This is not my specialist area- but isnât poor mental health, at least in part, affected by a personâs adverse life experiences, so that someone who has grown up in an impoverished and insecure home, fearful and with a poor sense of self-worth, is far more likely to be referred to mental health services than a person to whom these do not apply? Does that help explain the disparities in the ethnicity statistics that you cite?
We know that racial discrimination and abuse is shockingly widespread, but is it fair to say that Black people from a secure, loving home are likely to be better equipped to cope mentally than those who are not?
This approach would support Lord Sewellâs conclusions to some extent (though in his anxiety to avoid an overly simplistic approach he gives the impression of minimising the impact of race altogether). From memory it was also reflected in Wesselyâs 2018 discussions.
Or am I myself being too simplistic? I would value hearing from someone with more direct experience of these issues than I have.
Some like me do not find it âoddâ at all. Why? Because there are consistent patterns of âodditiesâ in your social democracy. So, those who are too busy to see the patterns and join the dots often find an âawakeningâ.
There are two main factors at play in the stats: 1) genetics and 2) macrocultural effects.
I donât have a way to âprovide evidenceâ for the power of the latter. Modern UK has a problem - admitting that there are so many strands of institutional racism woven into its society that it causes nausea and a Semmelweis Reflex (which is not about vomiting).
The issue is beyond âstatisticsâ. Itâs in the domain of common sense; that rare commodity these days.
Anyone who was around for the last 35 years could if they were so inclined dig into history and see the words âInstitutional Racismâ. For starters here is a relevant list:
National Health Service (2024 COVID-19 Public Inquiry / 2022 BMA Report)
England and Wales Cricket Board (2023 ICEC Report)
London Fire Brigade (2022 Independent Culture Review)
The Labour Party (2022 Forde Report)
The Church of England (2021 Anti-Racism Taskforce Report)
You may not find the words exactly as âInstitutional Racismâ in those. Why? Have you heard of âwokismâ?
But the picture is clear enough even if one or two of the pixels are slightly misaligned.
The concentration of ethnic minority doctors is not a âgenetic issueâ at its core. Itâs a reflection of a pathology in our society. But.. but.. people feel tarred by terms that have the word âInstitutionalâ in it. After all no self-respecting person declares âIâm a racistâ.
Cultures of racism concentrate issues into various pockets and then people navel gaze when in reality they should be gazing at the cultures of work and personal life they inhabit.
A culture is not a âthingâ that has self-awareness. Cultures are no living self-aware entities. Happy to side-track on to debate that. But I only am allowed two more responses in this thread.
Individuals have self-awareness. Change begins with each of us. But change cannot start if people are too busy picking their battles - and I guarantee any reader that nobody in their right minds has the energy or courage to stand up and be counted. Why? Itâs dangerous. What - people really donât know what Iâm talking about? I do not have the liberty of 5000 words to explain it here and I cannot reduce the issue appropriately into a 30-second read.
Is it anything to do with the fuzzy nature of some, donât know the figures, determinations of mental disorder and risk when the decision of the presence of mental disorder justifying detention are based on not clearly defined criteria i.e. no objective tests, but the judgement of, as far as I know for section 2, two docs and one AMHP to recommend detention, and another AMHP to execute detention. So it may be a question of the validity of judgement of four people. So how good is judgement in these complex areas, quite a lot of literature about judgement inconsistencies amongst professionals and psychiatrists feature as not so good, but with the caveat that the situations are very complex i.e. you probably would not do better. But these decisions are taken in real time under all kinds of pressures by people albeit trained for long periods, but still fallible people with their history influencing their decisions. With regard to people from different cultures the assessment of risk possibly is less accurate and perhaps the signatures of mental disorder are not clear and perhaps the assessment of risk trumps clear mental disorder determination. Until the fuzz clears in this area, the fallibility of people in spite of their best intentions could skew decisions. Wonder what the decisions of doctors and AMHPs from similar culture as the subjects are compared with a mismatch.
I hesitate to respond as a someone who is Pale and Stale (and Male), but a couple of concepts have really struck home to me over the years in relation to the overrepresentation of black people (particularly African Caribbean) in the mental health system.
Firstly, a now very old publication, Breaking the Circles of Fear, published by the (then) Sainsbury Centre for Mental Health in 2000 gave a very persuasive account of how black people are treated by the state and how they are reluctant to come forward for early support, thus leading to more severe outcomes. It may be 26 years old, but I still feel it has a relevant message.
The other concept which I heard via Professor Frank Keating at Royal Holloway University of London is of âracial weatheringâ (I donât believe he coined the phrase) - the cumulative impact of economic, financial, housing, health, criminal justice disadvantage/oppression, which impacts on individuals.
I think this latter concept combines the individual with the societal. Not every person of colour will experience mental ill health, but no person of colour will experience the white privilege that I have, which means I donât get stopped regularly by the police, for example. I donât have to live with these ongoing, lifelong stresses, which must surely take their toll on peopleâs mental well-being.
Returning to the original post, the review of the Mental Health Act was initiated in (I think) 2018 by Theresa May, with a clear remit to address racial disparities. I never felt that changing the law was likely to address these inequalities, but the explicit intention was there in the review. However, in the ensuing years, the focus on racial disparities seems to have been largely forgotten in the legislative agenda. Certainly the Patient and Carer Race Equality Framework (PCREF) has been rolled out in a number of (not all) trusts and hopefully bears some fruit, but this is outside the legislative review, and there was nothing explicitly focused on this in the changes to the Act. For example, the suggestion that culturally sensitive advocacy be made a legislative requirement was not taken forward in the review.
None of us should hesitate to respond based on our race, age or sex, no matter what it is.
My question was partly about why this issue is framed simply as Black vs White, when those two groups are not at the top and bottom of the charts. There is a broad range of outcomes for different groups. You mention being stopped by the police. The statistics for that seem similar to those for MHA detention, in that Indian and Chinese (alongside Arab and Roma, in the case of stop and search) are below White, and the Black groups are at the high end: Stop and search - GOV.UK Ethnicity facts and figures.
The other part of my question was about the idea that the doctors and social workers (and other professionals) who apply the MHA are doing so fairly, which I had never seen in writing before reading Prof Singhâs views in the Times article.