NHS psychiatrists are facing pressure to avoid detaining psychotic black patients under the Mental Health Act, with nine current and former mental health professionals reporting that they have been discouraged from sectioning individuals due to concerns about appearing racist.
The health service has been accused of introducing what critics describe as positive discrimination measures in response to official data showing that black people are significantly more likely than white people to be compulsorily detained. Figures for the year to March 2023 showed black patients were 3.5 times more likely to be sectioned; more recent data covering April 2024 to March 2025 indicates the rate has risen to four times that of white patients. The disparity is even starker for Community Treatment Orders, where black individuals are issued them at more than 8.5 times the rate of white people.
Pressure on psychiatrists
Medical professionals who have come forward describe an environment in which clinical judgement is being overridden by a perceived need to address ethnic disparities in detention statistics. One former NHS doctor said: “Once a patient has psychosis, we shouldn’t perform sociology, we should perform medicine.” Colleagues have condemned the approach as “scientific illiteracy” and accused policymakers of “jumping on bandwagons”.
The most high-profile example of these dynamics is the case of Valdo Calocane, who suffered from paranoid schizophrenia and fatally attacked three people in Nottingham in June 2023. The ongoing Nottingham Inquiry has heard that mental health professionals considered research on the over-representation of young black men in custody when deciding not to detain Calocane following a violent incident in 2020. It later emerged that Calocane had been sectioned four times between 2020 and 2023. His mother has said the mental health system is “broken” and that “no one listens to you” until a crisis occurs.
A former physician who worked at the same trust that had treated Calocane revealed that regulators visited his ward shortly before the killings and informed him there were too many black patients present. Professor Sir Robin Murray, a leading psychosis researcher at King’s College London, acknowledged that “political pressure” exists to lower sectioning rates for black individuals.
Complex factors behind the data
Psychiatrists and researchers argue that the elevated detention rates among black patients stem from a range of underlying risk factors rather than simply institutional racism within the NHS. They point to social deprivation as a major contributor: detentions under the Mental Health Act are highest in the most deprived areas of the country, and living in such areas is linked to increased risk of depression and other mental health problems through stress, social comparison and lack of resources.
Family breakdown and father absence have also been identified as significant predictors of mental health difficulties, particularly for teenage boys. Studies indicate that boys growing up without a father are at higher risk for a range of negative outcomes, including mental health issues. Other factors cited by medical professionals include exclusion from education, absent fathers, and high rates of cannabis consumption. Research from King’s College London, where Professor Sir Robin Murray is a senior researcher, has demonstrated a link between cannabis use — particularly high-potency “skunk-like” varieties — and an increased risk of psychosis. This risk appears to be independent of genetic predisposition and is higher with daily use of potent cannabis, with the risk increasing the younger a person starts.
Patterns of migration have also been raised as a contributing element, with some psychiatrists noting that health conditions affect different racial groups in distinct ways. Professor Murray drew an analogy with physical health, pointing out that black people have an increased risk of sickle cell anaemia and prostate cancer, yet no one accuses urologists of being racist for treating those conditions. “It’s akin to saying that it’s very unfortunate that so many black patients are having treatment for prostate cancer, so we should decrease the number having operations,” he said.
An epidemiology professor has warned that attributing all disparities in detention to institutional racism “doesn’t pass the sniff test” and risks denying treatment to those who genuinely require it. Lord Sewell, who chaired the 2020 Commission on Race and Ethnic Disparities, accused UK public health research of being “captured by American critical race theory” and influenced by activists promoting “urban myths” regarding the treatment of black men. The commission’s 2021 report controversially concluded that the “claim the country is still institutionally racist is not borne out by the evidence”. Lord Sewell argued that community orders frequently provide young men with positive outcomes, yet such stories remain overshadowed by negative narratives.
Professor Swaran Singh, an NHS consultant psychiatrist and professor at Warwick University who has published extensively on culture and ethnicity in mental health, insisted that treatment decisions should be guided by clinical requirements rather than ethnicity. “A diagnosis of serious mental illness should not become a shield that allows people to repeat offences just because they have a mental illness,” he said.
Risk of harm
Psychiatrists contend that restricting detentions based on race ultimately harms the very patients these policies aim to protect, denying them essential care while simultaneously elevating risks to public safety. Several doctors drew parallels with the Rotherham grooming gangs scandal, where police failed to intervene against predominantly south Asian perpetrators due to fears of racism accusations.
Peter Carter, formerly chief executive of the Central and North West London Mental Health NHS Trust and later general secretary and chief executive of the Royal College of Nursing, described decisions not to detain black patients on racial grounds as “indefensible” and “racist”. He insisted that clinicians “must be held to account”. The independent Themis investigation into Valdo Calocane’s care identified “clear failings” and produced recommendations.
Meanwhile, the Mental Health Bill intended to reform the Mental Health Act 1983, introduced by the Labour government, has not progressed. The charity Mind has been advocating for reforms including time limits on Community Treatment Orders and tackling racial inequalities. NHS England has been approached for comment.