HMN 2025: How Inequalities in mental health compulsory admissions worsened during the pandemic

New research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) and South London and Maudsley NHS Foundation Trust has shown striking inequalities between ethnic groups in the rate of involuntary admissions to mental health units during the COVID-19 pandemic.

The study found that involuntary admissions under Mental Health Act increased by 50% for Black people during the pandemic.

Researchers call for Mental Health Act reforms to consider these findings and provide support for initiatives such as the Patient and Carer Race Equality Framework (PCREF) which has demonstrated clear evidence of reducing health inequalities in a pilot at South London and Maudsley.

Disparities in involuntary admissions under Mental Health Act

People are admitted to mental health units under the Mental Health Act when they are experiencing a mental health disorder and considered to be a danger to themselves or others. This is known as ‘sectioning’ and involves assessment by a mental health professional.

Prior to the pandemic, Black Caribbean and Black African people were more likely to be admitted to mental health units through involuntary routes. The COVID-19 pandemic affected the provision of mental health services and this new study has assessed whether the two periods of lockdown further impacted the ethnic disparities in involuntary admissions.

Published in the British Journal of Psychiatry, the study compared daily admissions of people to a large secondary mental health care provider during the pandemic. They assessed rates of involuntary daily admissions (under the Mental Health Act) before and after the two “lockdown” periods in 2020 and 2021 and compared admissions over this period to previous pre-pandemic years (up to 2019), accounting for seasonal and weekly trends in admissions.

The analysis used data from the Clinical Records Interactive Search (CRIS) system, which are ethically approved deidentified patient-level and hospital admissions data from the South London and Maudsley NHS Foundation Trust.

Detention rates before and after lockdowns

Researchers found that during the first lockdown there was a drop in the overall number of admissions per day while admissions in the second lockdown stayed relatively similar compared to the pre-lockdown period.

“Our findings suggest that COVID-19 lockdown measures may have exacerbated existing inequalities in mental health care pathways. Although overall admissions to mental health units dropped during the first lockdown period, our study suggests that relative to comparable pre-pandemic periods, the number of people detained under the Mental Health Act has increased during both lockdowns for the Black Caribbean group and during the second lockdown for the Black African group,” said lead author Rosanna Hildersley from IoPPN, King’s College London.

Despite an overall drop in mental health admissions, there was an approximately 25% overall increase in the number of people detained under the Mental Health Act per day in the first lockdown compared to the comparison period, before the pandemic started. The increased rate in number of people detained under the Mental Health Act remained high in the second lockdown and after the second lockdown ended, compared to before the pandemic.

Exacerbation of ethnic disparities

During the lockdowns, there was a larger increase in the number of Black Caribbean people detained under the Mental Health Act per day, compared to the time before the pandemic started. The rate of Black Caribbean people detained each day was 54% higher in the first lockdown and 53% higher in the second lockdown. The rate also remained higher after both lockdowns finished. Black African people were more impacted in the second lockdown and were 57% more likely to be detained under the Mental Health Act compared to pre-pandemic periods.

“This research highlights the shocking inequalities faced by minoritized ethnic communities in our mental health system and how they are exacerbated by events such as the pandemic. We need to face the facts and listen to the voices of patients and carers, both of which are at the heart of PCREF—the first anti-racism framework from the NHS. By adopting PCREF we can be transparent and dedicated in our efforts to improving the access, experience and outcomes for minoritized ethnic groups, achieving this at local level through harnessing the knowledge of communities,” said Dr. Jacqui Dyer, co-author of the study from King’s College London, Mental Health Equalities Advisor for NHSE and PCREF lead at South London and Maudsley.

Senior author, Professor Jayati Das Munshi, Professor of Social and Psychiatric Epidemiology at IoPPN, King’s College London said, “The findings are very concerning—the 2018 Independent Review of the Mental Health Act highlighted that Black and other minoritized groups were more likely to be detained under the Mental Health Act when compared to the general population and our study shows these inequalities seem to have been exacerbated during the pandemic.

“There are several possible reasons for these findings: the pandemic led to changes in service provision and a reduction in community support alongside a potential association of lockdowns with worse mental health for some people. The Mental Health Act Review highlighted the role of structural racism in health care and criminal justice systems and what is clear from our study is that, in times of social crisis, the inequalities in treatment of people from ethnically minoritised groups gets worse under the current mental health system.

“Policy must recognize and address this evidence to ensure that anti-racist initiatives such as PCREF continue to be an integral part of our mental health services provision.”

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