Mental Health Act detention numbers fall for second year but significant racial inequalities persist

The number of detentions under the Mental Health Act 1983 in England has fallen for a second consecutive year, but significant racial disparities persist, official figures have shown.

MHA detention numbers fell by 7.7% on a like-for-like basis from 2021-22 to 2022-23, following a 5.7% drop the year before, showed data released yesterday by NHS England (formerly NHS Digital).

The reductions followed increases in detentions over the previous three years. However charities said use of the act remained high, demonstrating both the lack of investment in prevention and the urgent need to reform the MHA.

Though the government has pledged to overhaul the act, it has, effectively, ruled out doing so before the next election.

Reducing detention rates was among the key aims of MHA reform, along with cutting the significant racial disparities in use of the act.

However, the data showed these remained high, with detention rates for black or black British people 3.5 times those for white people.

Fall in detention numbers

NHS England recorded 51,312 detentions under the MHA in 2022-23, with most of these involving people being detained on admission to hospital for assessment under section 2 of the act (30,442).

This was down 3.8% from the 53,337 recorded in 2021-22. However, in neither year did NHS trusts and independent providers submit complete data, so NHS England published separate figures from 24 organisations for which it had reliable data going back to 2017-18.

They reported 21,411 detentions in 2022-23, down from 23,211 in 2021-22 and 24,604 in 2020-21, and their lowest recorded total in the six-year period.

The statistics also indicated a decline in the number of community treatment orders (CTOs), under which people discharged after detention have conditions placed on their treatment in the community, with the risk of recall to hospital if certain criteria are met.

The number of CTOs recorded fell to 5,157 in 2022-23, from 5,552 in 2021-22 and 6,070 in 2020-21, however these figures are based on incomplete data so are not comparable.

Racial disparities remain high

As in previous years, the detention rate was highest among black or black British people in 2022-23 at 227.9 per 100,000 population, 3.5 times the rate for white people (64.1). The rates were 74.7 for Asian people, 157.9 for those from a mixed background and 107.2 for those from the ‘other’ ethnic group.

The recorded detention rate for black people was 4.5 times that for white people in 2021-22, however, this does not represent a narrowing of the racial gap because of differences in the two datasets.

This year’s figures were based on the 2021 census, for which the population of black people was higher than for the previous 2011 census, which was used for the 2021-22 statistics. The white population remained stable from 2011-21.

So while similar numbers of detentions were recorded for black people in the two years (5,674 in 2021-22 and 5,348 in 2022-23), the rate per 100,000 population was significantly lower this year.

The number of detentions of white people fell from 33,311 2021-22 to 29,769 in 2022-23.

Black people were also eight times more likely to be placed on a CTO than white people, compared with 11 times in 2021-22, with this change also explained substantially by the shift to using the 2021 census.

Charities’ criticisms

The figures drew a critical response from mental health charities.

“Many of the tens of thousands of people who were detained under the Mental Health Act tried to seek help earlier, but the lack of options for accessing care in communities and long waiting lists meant they became more unwell,” said Mind chief executive Sarah Hughes.

She said the data illustrated the urgency of MHA reform, a point echoed by her counterparts at the Centre for Mental Health and the Race Equality Foundation, Andy Bell and Jabeer Butt.

“The disparities in use of the act remain stark, with Black people still nearly four times as likely to be detained than white people,” said Bell.

“It’s imperative that reforms to the Mental Health Act, now long overdue, are introduced early in the next Parliament, so that people receive fairer, safer and more compassionate care when they’re struggling with their mental health.”

Butt added: “The current Mental Health Act is 40 years old and reinforces mental health inequalities with its disproportionate use on racialised communities. We need to fix this law and put better protections in place as soon as possible.”