Black men’s experiences in detention expose widespread mental health system failures
The largest ever study on systemic racism across the UK mental health sector has exposed how Black men’s experiences of detention illustrate broader mental health system harm.
Over 200 Black men, families, community leaders and professionals informed and co-produced recommendations that directly inform the new White Paper on the UK Mental Health Act Bill.
Despite existing mental health legislation designed to curb the use of force, Black people in the UK are detained at more than three times the rate of White men and are more likely to experience coercive, harmful practices when in the care system.
Men involved in the NIHR funded study, Improving the Experiences of Black African Caribbean Men Detained Under the Mental Health Act: Co-Produced Policy and Practice Recommendations for Change and Reform (ImproveAct) (NIHR201715), described detention as the start of a cycle of fear, compliance, re-traumatisation and silence that tears through families and communities.
More than 40 Black men and family members were involved by using an innovative art-based approach, including masks, spoken word and poetry, to create culturally safe spaces where Black men, their families and their communities could share experiences of racism and fear of death during detention that that could be unsafe to share in clinical environments.
Many Black men reported being treated as ‘big, Black and dangerous’, rather than as individuals with complex identities, spirituality, and community ties, and spoke about feeling unable to safely voice distress or challenge poor care. The study illustrated that misinterpretations of trauma responses such as aggression led to excessive use of force, misdiagnosis, and over-medication. The research also urgently identified the need for trauma-responsive training to distinguish between mental health presentations and fear responses of historic trauma.
One patient said: “There’s a cage on the mouth… they caged up our mouths… and we’re unable to speak our hearts and what’s in our minds.”
Dr Alina Haines-Delmon, Reader and Associate Professor at the School of Nursing and Public Health at Manchester Metropolitan University, was co-lead for the project. She said: “As a research team, we heard clearly that Black men are not only underserved by mental health services, they are actively harmed by them.
“What this study shows is that these experiences are not isolated incidents, but patterned consequences of the way risk, race and distress are interpreted in practice. Crucially, the men, families, community pillars and professionals involved in the detention process have also offered clear, practical solutions.
“Rebuilding trust in mental health services will require acting on this knowledge, not just listening to it. If the forthcoming Mental Health Act reforms are to deliver meaningful change, they must be grounded in evidence generated with those most affected and embed accountability for trauma-responsive, anti-racist care at every level of the system.”
The study illustrated that many Black men left the system not helped or healed, but re-traumatised. The study participants reported that while in the care system they experienced years of struggling to challenge coercive practices, segregation and over-medication, often experiencing gaslighting when raising concerns about racism and inequality. They told of Inevitably, falling ill again and being too fearful to reach out to services for help.
According to the study, families reported ‘hiding’ their relative to attempt to avoid re-traumatisation, but without help this then led to men reaching crisis point, leading to further detention.
Elaine Craig, Senior Research Assistant in Mental Health at Manchester Metropolitan University and ImproveAct project manager said: “We have uncovered an institutionalised framework of systems harm in mental health services, where services built to care and protect are instead actively traumatising people. This should be recognised as a public health crisis.
“Our findings reveal a mental health system where Black men’s humanity is overshadowed by pathology and negative stereotypes. Until services see the person behind the labels they will keep misdiagnosing trauma as danger.”
Craig added: “When families tell us they hide their loved ones from services during crisis rather than contact them as a first resort of care and protection, the system has failed, it has lost the trust that makes healing possible. Our findings set out practical steps to start to rebuild that trust and to repair harm.”
From Mental Health Detention to Health Systems Reform: Co-producing Policy and Practice Recommendations with Black Men, their Communities, and Health and Social Care Professionals, is published in PLOS Mental Health here: https://doi.org/10.1371/journal.pmen.0000457[EC1]
