The Case for Change
The evidence is clear.
Racism — not race — drives mental health inequities for Black people in England. The data is unambiguous. The system is failing. And it has been failing for decades.
The Crisis in Numbers
Key statistics
These are not abstract numbers. Each represents real people failed by systems that were not designed with them in mind.
Prevalence & Treatment
23%
Black adults experiencing a common mental health problem weekly — compared to 17% of White British adults.
NHS Digital, Adult Psychiatric Morbidity Survey, 2016
6%
Black adults receiving treatment for mental health problems — compared to 13% of White British adults. The treatment gap is widening.
NHS Digital, Adult Psychiatric Morbidity Survey, 2016
10x
Black men are ten times more likely to experience psychosis (3.2% vs 0.3% for White men).
NHS Digital, APMS, 2016
8%
Prevalence of PTSD among Black adults, double the 4% rate for White British adults.
NHS Digital, APMS, 2016
Detention & Coercion
3.6x
Higher detention rate under the Mental Health Act for Black people compared to white people. Black people are nearly four times more likely to be sectioned.
NHS Digital, Mental Health Act Statistics, 2022/23
Disproportionate
Community Treatment Orders are disproportionately issued to Black patients, extending coercive control beyond hospital walls.
CQC, Monitoring the Mental Health Act, 2023
Criminal Justice & Education
9x
Black people are almost nine times more likely to be stopped and searched by police. Negative police interactions increase risks of PTSD and depression.
Home Office, Stop and Search Statistics, 2023
53%
More likely to be sent to prison for an indictable offence if you are Black, compared to white defendants.
Lammy Review, 2017
~2x
Black Caribbean children are nearly twice as likely to be permanently excluded from school. Exclusions predict the onset of new mental health problems.
DfE Exclusion Statistics; Gutman & Vorhaus, 2012
The Funding Gap
9 in 10
BAME-led charities were at risk of closure within the first three months of the COVID-19 pandemic. Black-led organisations have solutions but are held back by a chronic lack of sustainable funding.
Voice4Change England & ACEVO, 2020
Setting the Scene
The system wasn’t designed for us
Racism is a public health crisis and this crisis manifests in numerous areas of health, including mental health. The mental health system in England was built on white, Eurocentric norms. Its diagnostic frameworks, treatment models, and commissioning structures were designed without Black communities in mind. The field of psychiatry itself has origins entangled with eugenics and scientific racism — frameworks that pathologise and harm Black people.
Despite improvements made in healthcare over the past few decades, inequities in access, experience and outcomes continue to persist, particularly for Black people. It is important to understand that these stark disparities are often rooted in racism and discrimination within the health and mental healthcare system, but also in the wider society — not just interpersonal racism and discrimination, but also systemic and institutional.
This is not new knowledge. Reports going back over 20 years — from the Blofeld Report (2003) to the Independent Review of the Mental Health Act (2018) — contain recommendations that remain unfulfilled. The David “Rocky” Bennett inquiry, Inside Outside, Delivering Race Equality, the Crisp Commission — each made urgent calls for change. Many of those same calls appear in this Manifesto because the system has failed to act on them. Many initiatives, reforms and improvements have not yet addressed the needs of Black communities in tangible ways, nor have they addressed that the mental health system has not been designed for the Black community, and as a result we continue to be harmed.
We know that Black people are more likely to experience a common mental health problem, have higher rates of PTSD and suicide risk and are more likely to be diagnosed with schizophrenia. We also know that race and ethnicity are not known risk factors for poor mental health, pointing to racism not race as the culprit. We know Black people are four times more likely to be detained under the Mental Health Act and are nearly eight times more likely to be put on a community treatment order, illustrating the ways in which systemic and institutional racism show up within the mental health system.
Putting these facts and figures aside, what sits behind them are real people. Real people having experiences that no one deserves to have. Real people who are being failed; robbed of their human rights, dignity, and justice.
The Black Mental Health and Wellbeing Alliance was formed because waiting for the system to fix itself is not an option. The Black Mental Health Manifesto sets out a manifesto for change and a radical future. This manifesto begs the question: are these systems operating in the exact way they were intended and, if so, what does a radically different future look like? The Manifesto is a demand for structural change — and a refusal to accept another 20 years of unfulfilled promises.
The Economic Case
The cost of inaction
£118bn
Annual cost of mental ill-health to the UK economy — through lost productivity, benefit payments, and health and social care costs.
McDaid et al, London School of Economics, 2022
Addressing racial disparities in mental health is not only a moral imperative — it is an economic one. When Black people are detained rather than receiving care, when community organisations are defunded, when practitioners lack appropriate skills, knowledge and awareness, the costs are borne by everyone.
Investment in prevention, community-led services, and culturally responsive interventions delivers better outcomes at lower cost. The NHS Long Term Plan acknowledges this. The evidence supports it. What is missing is the will to act.
A mental health system in which Black people can flourish is a system that works better for everyone.
Organisations in Action
Who is acting on the manifesto?
The manifesto is a framework for action, and this is where the Alliance features what organisations have done with it — commissioning changed, funding shifted, services redesigned, recommendations made real.
Has your organisation acted on a manifesto recommendation? Tell us what you did and we’ll feature it. Not sure where to start? See implementing the recommendations.
These numbers demand action
The evidence is overwhelming. The disparities are documented. What happens next depends on all of us.