Less care, more control: unpacking inequalities in the UK’s mental health system

One in four people will experience a mental health problem each year in England. That’s around 14 million people – enough to fill Wembley Stadium over 150 times. And yet, access to care is anything but equal, especially if you’re Black or brown.

Let’s start with a few figures:

• Black adults are more likely to experience mental health problems, yet also receive the lowest treatment rates of any ethnic group.
• Black people are disproportionately diagnosed with serious mental health conditions, but their trauma is often disregarded.
• Rather than through early intervention or GP referrals, Black adults typically enter services through crisis or criminal justice routes.
• The prevalence of psychotic disorders is over 10 times higher in Black men than in white men, yet misdiagnosis and over-medicalisation remain rampant.

The stats are sobering, the stories are heartbreaking, and the silence? Deafening. Despite the fact that the system is built on unequal foundations, many services continue to operate under the premise that healthcare is impartial and evidence-based. And when racism is acknowledged, it’s framed as personal prejudice rather than a systemic problem, which stops meaningful change in its tracks.

Cultural attitudes and stigma create a barrier too. For many people from ethnic minority backgrounds, mental health remains a taboo subject, shaped by community expectations, generational beliefs, and the pressure to keep struggles under wraps. But when services – built on Eurocentric models – feel unsafe or culturally out of touch, speaking up can feel riskier than suffering in silence. Especially when the system rarely reflects the communities it claims to serve.

Despite years of research, racial inequalities in mental health care continue to persist unchecked. And too often, what’s labelled as “care” looks and feels like control. Restraint, isolation, and forced medication are routine responses, not rare exceptions. Black people also experience higher rates of trauma while in care; a symptom of a system shaped by structural racism where distress in Black people is pathologised and criminalised.

But wait, there’s so much more. In the UK, Black people are:

• Four times more likely to be restrained during mental health interventions
• Four times as likely to be detained under the Mental Health Act
• Over 10 times more likely to be placed under Community Treatment Orders than white people.

Tackling individual prejudice, with things like unconscious bias training, without addressing structural racism doesn’t mend the issue, it only puts a plaster on what’s clearly a gushing wound. It’s lazy and lets institutions off the hook.

Real change means:

• Amplifying lived experience, not just as case studies but in conversations on policy change and system restructure
• Fixing voluntary support pathways so early intervention is accessible, safe, and culturally competent
• Funding community-led, person-centred services to help build trust where institutions have failed
• Embedding anti-racism into mental health systems – from recruitment to training to service design
• Holding systems to account for racial disparities in treatment, outcomes, and access.

Yes, individual health care professionals still have a responsibility to learn, unlearn and relearn, but equality in mental health care demands structural overhaul, not surface-level alterations. And if we want to build systems that truly support everyone, we need to start by listening to those they’ve left behind.