It’s time to tackle the trap of inequality and mental illness

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Data on Mental Health Act detentions in 2022/2023 in England¹ shows that Black people, and people living in areas of socio-economic deprivation, are more likely to be detained than any other group.

This pattern has persisted for several years and reflects the vicious cycle of inequality and mental illness affecting too many patients.

Today’s data does, however, show some improvement that the College welcomes.

Inequality contributes to the development of severe mental illness. In turn, mental illness can increase inequality, particularly for people who reach crisis before receiving specialist help. The College warns that this trend will continue until the Government properly resources mental health services, and reforms the Mental Health Act.²

In 2018, Professor Sir Simon Wessely led a major review of the Mental Health Act (the Act) which made recommendations on what reforms were needed to reduce detentions and the disproportionate use of the Act on Black people. Government had started to review what legislation could be implemented; however, the reforms were not in the King’s Speech and therefore will not be introduced in this Parliament.

Between April 2022 and March 2023, 51,312 people were detained under the Act, which is the equivalent rate of 91 people in every 100,000.

Despite the data showing some improvement, people from minoritised ethnic groups are still less able to access mental health support when they need it, which means they are more likely to go into crisis and are more likely to be detained.³ Black people from Caribbean backgrounds are the most severely affected by this mental health inequality.

In the year to March 2023, 5,348 Black or Black British people were detained under the Mental Health Act, a rate of 228 per 100,000 people. This is a welcome reduction from 2021-2022, when Black people were detained at a rate of 342. However, it is still 3.6 times higher than the rate of detention among white people, which was 64.

Economic disadvantage also has an impact on people being detained under the Act.⁴ 7,973 people (148 per 100,000 people) who were detained were from the most deprived communities in England, compared to 2,101 (40 per 100,000 people) in the least deprived areas.

The College wants the next Government to reform legislation so that all patients with mental illness can make advance choices regarding their treatment if they become so unwell that they may need to be detained. Advance choice documents encourage patients to voice their views about any future inpatient care. There is strong evidence that these have the potential to lower the rate of detentions by up to 25% overall and in particular, increase the sense of autonomy for Black patients.

Ahead of the general election, the College is calling on all parties to commit to reducing the prevalence of mental illness in the population. For more information on our priorities for addressing inequalities in mental healthcare, see Preventing Mental Illness, our manifesto for the next UK general election.

President of Royal College of Psychiatrists, Dr Lade Smith CBE, said:

“Inequality engenders mental illness, and people with mental illness are treated inequitably.

“It is welcome that for the first time we have seen a reduction in detentions among Black people, but today’s data shows how far we still have to go. It is obvious what needs to be done - and the Mental Health Act review provided the blueprint.

“We have not seen sufficient action from Government to tackle the underlying causes of detentions under the Mental Health Act. It is astonishing that in England in this day and age, being poor or being from a minoritised ethnic community means you are more likely to have a mental health problem, more likely to go into crisis and therefore more likely to be detained.

“In the absence of legislative reform, the Royal College of Psychiatrists will continue to work with Government, NHS and patient groups to promote the dignity, autonomy and rights of people subject to the Act, while also pushing for the legislation to be introduced at the earliest opportunity.

“In addition to those detained, there are many others living with mental illness who are not able to access services at all, often from minoritised ethnic groups and marginalised communities. There are also a growing number of children and young people who will become adults with mental illness. It doesn’t have to be this way. We need the Government to provide psychiatrists with enough resource to deliver specialist treatment long before people reach crisis point.”

References

1. Due to a cyber incident that occurred in 2022-23 which impacted data for the months between August 2022 and March 2023, NHSE have recommended that some caution is advised when interpreting the data included in this publication.
2. The Mental Health Act provides the legal authority to keep people with mental illness who are extremely unwell in hospital, if their illness risks their own welfare, or that of someone else. For more information about the Mental Health Act see our information page on mental capacity and the law.
3. See tables 1c and 1g in the NHS England publication on the number of detentions under the Mental Health Act 1983 between April 2022 and March 2023, broken down by ethnic group and Indices of Multiple Deprivation (IMD) decile, where IMD decile 01 is the least deprived and IMD decile 10 is the most deprived.
   
4. For additional information on mental illness and inequality see Fair Society, Healthy Lives (The Marmot Review 2010) and Health Equity in England: the Marmot Review 10 years on (The Health Foundation 2020)