Social workers believe that better funding and anti-racism training, not legislative reform, are key to reducing racial disparities in the use of the Mental Health Act 1983 (MHA).
This follows annual NHS England figures showing that black people continue to be disproportionately detained in hospital and placed on community treatment orders (CTOs) under the act.
Increasing racial disparities
In 2024-25, white people continued to account for the majority of detentions. However, their detention rate per 100,000 population, when adjusted for factors such as age and sex, was lower than that of all other ethnic groups, and the only one to fall since 2023-24.In contrast, rates rose among all minority groups, with the steepest increase being among black and black British people, for whom the rate rose from 242.3 to 262.4.
Black people were also eight-and-a-half times more likely to be placed under a CTO, which puts conditions on people's treatment in the community following discharge, with responsible clinicians able to recall patients to hospital under certain circumstances.
Calls for enhanced funding and anti-racism training
In response to the findings, both the AMHP (approved mental health professional) Leads Network (ALN) and mental health charity Mind called for amendments to the current Mental Health Bill, which will overhaul the MHA, to address these growing inequalities.However, most practitioners appear unconvinced that legislative change alone will make a difference.
Another 30% called for high-quality anti-racist and cultural competence training for AMHPs, who ultimately decide whether a person requires detention, and other relevant practitioners. A further 21% favoured diversifying the workforce to better reflect the communities served.
Just 12% said amending the Mental Health Bill to introduce stronger safeguards was the optimal way of tackling the inequalities.
'Develop a workforce that reflects the community you serve'
Comments under the related article mirrored some of the findings, with practitioners particularly highlighting a lack of diversity within the mental health workforce.One practitioner, who had seen three family members detained due to the "failings of the mental health system", said the lack of cultural understanding and representation fuelled mistrust within black communities.
“Had the white [managers] ever bothered to ask the community what was needed the response would have been: ‘Cultural and religious and ethnic beliefs are diverse and so develop a workforce from here that reflects the community you serve,’”, they added.
“Ask yourselves this: how many Afro-Caribbean descent psychiatrists have you met? Now, how many Afro-Caribbean patients detained under the MHA have you met?”
Aya, who described herself as Afro-Caribbean British, said black people were too often treated as a homogeneous group.
“All black people are lumped in as one by mental health services. My needs are not the same as yours, but I am treated as if they are,” she said.
“White managers made the decision to employ people in a manner that is not reflective of the community served and the silence of white professionals is a serious problem in this.”
‘Stop blaming legislation’
Sandra, an AMHP, criticised the ALN for failing to reflect on the role AMHPs play as decision makers in creating the disparities.“It’s not legislation that enforces racial disparities but professionals including AMHPs. It is shameful for AMHP leads to pretend they are not complicit,” she said.
“We have to own up to our profiling of all mental health patients and the consequences of that for people of colour. Be honest if you really care about racism and detention and outcomes, [...] treatment, and the general dismissal of the right to autonomy and decision making by patients and families.”
In response, ALN co-chair Nick Perry acknowledged that AMHPs were “implicated” in perpetuating the status quo.
“We should be accountable for being part of the system, even though our role is designed to work from a non-medical model perspective,” he added.
“If we can see things are not properly resourced, not working (and that government changes to the Mental Health Act will not improve things) then we are duty-bound to say that loud and clear.”
Some AMHPs 'lack experience of diversity'
Another AMHP warned that some practitioners were ill-equipped to work in diverse communities due to training and working in predominantly white areas.“This can perpetuate ignorance [and] breed racial discrimination when faced with people from backgrounds they rarely meet,” they said.
“I saw it in my last post where I went from a big urban multi-ethnic, multi-racial and multi-religious local authority to an area that was largely white British. We need to get people exposed to different races [and] beliefs, [rather] than listen to people in training rooms.”
They added that the outcomes of detentions were also sometimes shaped by AMHPs’ limited confidence or experience.
“Some AMHPs do need to be more confident in challenging doctors and healthcare colleagues. We are supposed to know the law and enough about our local systems to promote alternatives. Some AMHPs don’t do this.”
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