Mental health racial bias in England and Wales is ‘inexcusable’, says report

Ministers must use legislation to address an “unacceptable and inexcusable” failure to address racial disparity in the use of the Mental Health Act, MPs and peers have said.

The joint committee on the draft mental health bill says the bill does not go far enough to tackle failures that were identified in a landmark independent review five years ago, but which still persist and may even be getting worse.

Black people are four times more likely than white people to be detained under the Mental Health Act (MHA), and more than 11 times more likely – up from eight times higher in 2018 – to be given a community treatment order (CTO) in England, according to NHS statistics for 2021-22.

Some minorities are also more likely to spend longer in detention, experience multiple detentions, and be detained through contact with emergency departments or the criminal justice system.

The committee says the landmark 2018 review of the MHA by Prof Simon Wessely – which the bill is a response to – was intended to address racial and ethnic inequalities, but that those problems have not improved since then “and, on some key metrics, are getting rapidly worse”.

Lady Buscombe, the committee chair, said: “We believe stronger measures are needed to bring about change, in particular to tackle racial disparity in the use of the MHA. The failure to date is unacceptable and inexcusable.

“The government should strengthen its proposal on advanced choice and give patients a statutory right to request an advance choice document setting out their preferences for future care and treatment, thereby strengthening both patient choice and their voice.”

The report, published on Thursday, says that because CTOs represent “the starkest racial disparity in use of the act”, and due to evidence of their overuse as an alternative to discharge and doubts about their effectiveness, the orders should be abolished for most people. The proposed exceptions are for those involved in criminal proceedings or under sentence, where their continued use should be reviewed.

Other key recommendations include explicitly including a requirement to respect racial equality in the bill, and mandating that health organisations appoint a responsible person to collect and monitor data on detentions under the MHA, broken down by ethnicity. These should feed into annual figures published by the government and policies that reduce inequalities.

The committee heard evidence that showed it was difficult to legislate to directly affect racial discrimination, especially where legislation already existed, such as the Equality Act and public sector equality duty.

The report states: “Whilst it is difficult to legislate for unconscious bias, or for clinicians to consider the experience of minority groups, the code of practice may guide those using the MHA to consider these factors – that ‘anti-racism be enshrined in the act as a guiding principle.’”

The committee also recommended stronger duties on commissioning bodies to ensure adequate supply of community services in order to end the inappropriate long-term detention of people with learning disabilities and autistic people.

A Department of Health and Social Care spokesperson said: “We are taking action to address the unequal treatment of people from Black and other ethnic minority backgrounds with mental illness – including by tightening the criteria under which people can be detained and subject to community treatment orders.

“The government will now review the committee’s recommendations and respond in due course.”