A "shameful" and "gut-wrenching" rise in racial disparities in the use of the Mental Health Act 1983 has prompted calls for changes to the government bill's to reform the legislation.
The AMHP (approved mental health professional) Leads Network and the charity Mind both called for amendments to the Mental Health Bill to tackle racial inequalities in the use of the MHA, after annual NHS England figures showed a widening in the gaps in rates of detention and the use of community treatment orders for black and white patients respectively.
Though one of the aims of the new legislation is to address the longstanding issue of the act's coercive powers being used disproportionately on black people, the network warned that the bill, as currently constituted, would do "nothing" to address racial inequalities.
Use of Mental Health Act in 2024-25
There were 52,731 detentions under the MHA in 2024-25, 38,063 at the point of admission, 11,353 following admission to hospital and 3,253 after the person had been removed or kept at a place of safety under sections 136 or 135. As in previous years, detentions for assessment, under section 2 of the MHA, accounted for the majority of cases (37,012).The total figure represented a 0.5% increase on the 52,458 recorded in 2023-24.
However, because not all providers submit data, NHS England makes year-on-year comparisons based on a subset of services, among which the number of detentions fell by 4.9% in 2024-25, following a 2.5% increase the previous year.
Widening racial gap
While white people continued to account for the majority of detentions, their detention rate per 100,000 population, when adjusted for factors such as age and sex, was both lower than that of all other ethnic groups and the only one to fall from 2023-24 to 2024-25, going from 68.4 to 65.8.Rates increased for the mixed (from 177.1 to 187.5 per 100,000), Asian (from 82.5 to 88.5) and other (from 129.4 to 136.9) groups, with the highest increase being among black/black British people, for whom the rate per 100,000 rose from 242.3 to 262.4.
This was four times the rate for white people, an increasing disparity compared with the three-and-a-half times greater likelihood recorded for 2023-24.
Increasing inequalities in use of CTOs
It was a similar story in relation to community treatment orders (CTOs), which place conditions on patients’ treatment following their discharge, with responsible clinicians able to recall them to hospital if they deem that they require treatment and there would be a risk to them or others if they weren't recalled.NHS England said there were 6,575 new CTOs in 2024-25, compared with 5,618 in 2023-24, thought it stressed that these figures were affected by data quality issues.
Though the rate of CTO uses among white people grew from 2023-24 to 2024-25, rising from 6.9 to 7.5 per 100,000 population, the rate for black people increased much more significantly, from 48.8 to 61.3 per 100,000 people.
As a result, black people were eight-and-a-half times as likely to be placed under a CTO than white people in 2024-25, compared with seven times as likely in 2023-24.
'Shameful figures a damning indictment of UK government
For Mind, chief executive Sarah Hughes said the "shameful figures" showed the "human cost of inaction on mental health"."The racial inequalities in mental health crisis care are longstanding but the fact they are worsening is a shocking indictment of the UK government," she added. "Mental health services are failing Black people. Mind is calling for urgent interventions to tackle the over detention of Black people and culturally appropriate care."
When it published the Mental Health Bill last November, the government said that addressing racial discrimination in the use of the act was one of its aims, along with reducing the overall use of detention and CTOs, ending the inappropriate detention of people with a learning disability and autistic people and giving patients a greater say in decisions over their care.
However, there are no specific measures expressly aimed at reducing racial and ethnic inequalities in the use of the MHA, an issue that has been highlighted in parliamentary debates on the bill.
'Gut-wrenching rise in detentions among racialised groups'
The chairs of the AMHP Leads Network (ALN) warned that the bill, in its current form "would do nothing" to address entrenched discrimination in the use of the act.They added: "The rising number of people detained from racialised groups is gut-wrenching, which is why we are lobbying Parliament to amend the current Mental Health Bill."
The bill, as stands, would require the MHA's code of practice to include four principles - choice and autonomy, least restriction, therapeutic benefit and the person as an individual - to inform decision making under the act.
The ALN has said that the "person as an individual" principle acknowledged the racial inequalities in the use of the act, but warned that, without the principles being written onto the face of the bill itself, they would not be enforceable.
Though it wants to see the therapeutic benefit principle replaced, it has called for the principles to be given greater enforceability by direct inclusion in the MHA, with decisions under the legislation requiring justification with reference to the specified values.
'Thousands waiting for hospital admission'
The ALN chairs added that NHS England's MHA data did "not show the whole picture", as it did not record numbers assessed by AMHPs under the MHA or those whose cases were considered by professionals prior to any assessment.Our members report that there are thousands of people waiting for admission under the Mental Health Act every week; many of them waiting in emergency departments for days on end, with no satisfactory legal framework to provide compulsory care and treatment, never mind an effective, less restrictive alternative."
The ALN chairs said in some cases people were having to be reassessed under the MHA because the two-week validity for the medical recommendations supporting the application to detain them had expired.
AMHPs' work in preventing detentions left unrecorded
They added that those detained represented "only a fraction of the individuals AMHPs are asked to assess with the view to considering the use of compulsory assessment or treatment", for whom professionals "work tirelessly to put alternative plans in place" to manage their mental health crises."These interventions reduce bed usage and prevent admission by supporting families and carers, the NHS and the third sector," they said.
The network wants the Mental Health Bill to be amended to require councils to collect data on demographics and outcomes for people referred for Mental Health Act work, not just for those whoa re detained.
The chairs said this would "give this vital work its deserved prominence in mental health crisis care" and ensure that "resources aimed at preventing hospital admission and reducing mental health inequalities are more appropriately targeted".
MPs set to consider Mental Health Bill
The bill has already passed through the House of Lords and is due to enter its final stages in the House of Commons next month, after which the two houses must agree a final version of the bill.Mind said it was pushing for amendments that put time limits on CTOs, tackle racial inequalities at local and national levels, give young people more say in their treatment and end the use of out-of-area placements or adult wards for children.
Chief executive Sarah Hughes added: “MPs will soon have a final chance to vote through bold, transformative amendments to the Mental Health Bill, to make the Mental Health Act fit for the 21st century. Mind stands ready to work with politicians to deliver a new deal for mental health that tackles racism head on and strengthens the rights of people at their most unwell.”
