Black men’s detention experiences expose 'systems harm' in mental health care

The NIHR-funded ImproveAct 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 (NIHR201715) – involved more than 200 Black men, families, community leaders and professionals. Their evidence and co-produced recommendations directly inform the new White Paper on the UK Mental Health Act Bill.

Despite existing legislation intended 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 and harmful practices while in care.

Men involved in the study described detention as the beginning of a cycle of fear, compliance, re-traumatisation and silence that tears through families and communities.

More than 40 Black men and family members took part in an innovative art-based approach using masks, spoken word and poetry to create culturally safe spaces. These spaces enabled participants to share experiences of racism and fear of death during detention that they felt could be unsafe to disclose in clinical environments.

Many reported being treated as “big, Black and dangerous”, rather than as individuals with complex identities, spirituality and community ties. Participants spoke of feeling unable to safely voice distress or challenge poor care.

The study found that trauma responses such as aggression were often misinterpreted, leading to excessive use of force, misdiagnosis and over-medication. It also identified an urgent need for trauma-responsive training to help practitioners distinguish between mental health presentations and fear responses rooted in 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 and co-lead for the project, 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 research found that many Black men left the system not helped or healed, but re-traumatised. Participants reported years of struggling to challenge coercive practices, segregation and over-medication, and described experiencing gaslighting when raising concerns about racism and inequality. Many spoke of inevitably falling ill again and being too fearful to reach out to services for help.

Families reported ‘hiding’ their relative to try to avoid re-traumatisation. However, without support this often led to men reaching crisis point and 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.”