Barriers for BAME communities to accessing mental health services

A qualitative study exploring barriers to mental health service access among Black and minority ethnic communities in southeast England.

Key messages

  • stigma, cultural identity, reluctance to discuss distress and financial challenges hinder recognition of mental health problems and help-seeking
  • long waiting times, language barriers and poor communication damage relationships between service users and providers
  • mental health needs are often inadequately recognised within services
  • power imbalances, cultural naivety, discrimination and limited awareness of available services particularly affect Black and minority ethnic service users.

Policy implications

  • mental health services may need to address stigma and cultural barriers as part of access pathways
  • communication and language support should be improved to strengthen service user–provider relationships
  • staff training may need to focus on cultural awareness and power dynamics in care interactions
  • clearer information about available services could support earlier access.

Gaps

  • limited evidence on how these barriers vary across different ethnic groups
  • lack of quantitative data on the prevalence or relative impact of identified barriers
  • limited evaluation of interventions designed to address power imbalances and discrimination.

Commentary
This study highlights how inequities in mental health care are shaped by a combination of personal, cultural and service-level barriers. Stigma, cultural identity and reluctance to discuss distress limit help-seeking, while financial pressures further restrict access to support.

Service-level factors compound these inequities. Long waiting times, language barriers and poor communication weaken relationships between service users and providers, increasing the risk that mental health needs go unrecognised or unsupported.

The findings also point to unequal power dynamics within care interactions. Experiences of cultural naivety and discrimination, alongside limited awareness of available services, place Black and minority ethnic service users at a particular disadvantage.

From a care equity perspective, these barriers contribute to uneven access, experience and outcomes in mental health services. Addressing them requires changes to how services communicate, recognise need and share power with the people they support, rather than relying solely on individual help-seeking.

Ethnic disparities in Mental Health Act detentions

Annual statistics showing differences in Mental Health Act detentions and Community Treatment Orders between ethnic groups in England.

Key statistics

  • 52,731 detentions under the Mental Health Act were recorded in 2024–25, a 0.5% increase compared with 2023–24
  • detention rates per 100,000 population (age and sex adjusted):
    • white: 65.8
    • Black/Black British: 262.4
    • Mixed: 187.5
    • Asian: 88.5
    • Other: 136.9
  • Black people were four times as likely to be detained under the Act as white people
  • 6,575 new Community Treatment Orders were made in 2024–25, up from 5,618 in 2023–24
  • Community Treatment Order rates per 100,000: white 7.5; Black 61.3
  • Black people were 8.5 times as likely to be placed on a Community Treatment Order as white people
  • most detentions were under section 2 for assessment (37,012 cases).

Key messages

  • racial disparities in detentions and Community Treatment Orders have widened compared with previous years
  • white people were the only ethnic group to experience a fall in detention rates
  • all other ethnic groups saw increases in detention rates
  • concerns have been raised that the Mental Health Bill does not adequately address entrenched racial inequalities
  • official statistics do not capture people waiting for admission or preventative work by approved mental health professionals.

Policy implications

  • monitoring and action on racial disparities may need to be strengthened within Mental Health Act implementation
  • better data on assessments, diversions and preventative work could support more equitable crisis responses
  • expansion of early and community-based mental health support may reduce reliance on detention for racialised groups
  • legislation may require clearer duties to address disproportionality.

Gaps

  • lack of data on people waiting for admission to inpatient care
  • limited visibility of preventative and diversionary work carried out by approved mental health professionals
  • limited evidence on which policy or service changes reduce detention disparities.

Commentary
These figures show a clear and worsening inequity in how the Mental Health Act is applied across ethnic groups. Although overall detentions increased only slightly, Black people remain far more likely to be detained or placed on a Community Treatment Order than white people, indicating persistent disproportionality.

The data also highlight divergent trends. Detention rates fell for white people but increased for all other ethnic groups, widening existing gaps in experience and outcomes. This suggests that improvements in crisis care are not being experienced equitably.

Concerns raised about the Mental Health Bill point to a gap between principles and practice. While the Bill emphasises autonomy and least restriction, warnings that it lacks enforceable duties to address racial inequalities raise questions about its potential impact on long-standing disparities.

From a care equity perspective, the absence of data on waiting lists and preventative work limits understanding of the full system pressures shaping detention. Without recognising both unmet need and avoided detentions, policy and service responses risk overlooking opportunities to invest in culturally informed, community-based alternatives that could reduce inequitable use of compulsory powers.

Digital technology in mental health care

A review examining the impact of digital technologies in UK secondary mental health care, with a focus on innovation, data use and co-produced digital tools.

Key messages

  • digital technologies are increasingly used in secondary mental health care settings
  • co-production with people who experience chronic mental health conditions is essential to effective digital design
  • digital tools offer opportunities to improve understanding, monitoring and sharing of mental health data
  • innovation is occurring unevenly across services
  • evidence on effectiveness and long-term impact remains limited.

Policy implications

  • digital mental health tools should be co-produced with service users
  • secondary care services need support to evaluate digital interventions robustly
  • data governance and information-sharing arrangements are central to safe digital innovation
  • implementation should proceed cautiously alongside ongoing evaluation.

Gaps

  • lack of long-term outcome studies in secondary mental health care
  • small sample sizes limit generalisability
  • limited consideration of multiple protected characteristics
  • insufficient evidence on equity impacts of digital mental health tools.

Commentary
This paper highlights both the promise and the uncertainty surrounding digital technologies in mental health care. While new tools offer opportunities to enhance data sharing and clinical insight, their success depends heavily on alignment with service users’ needs and experiences.

A recurring theme is the importance of co-production. Digital tools designed without meaningful involvement of people living with mental health conditions risk being poorly adopted or misaligned with real-world care. This is particularly relevant in secondary care, where needs are often complex and long term.

At the same time, the review points to a thin evidence base. Small studies and short follow-up periods make it difficult to judge whether digital interventions improve outcomes or simply add complexity to already stretched services.

Overall, the paper suggests that digital innovation in secondary mental health care should prioritise learning and evaluation over rapid scale-up. Careful design, inclusive involvement and longer-term evidence are needed if technology is to strengthen care without introducing new forms of exclusion or risk.

Improving access for digitally excluded people using mental health services

A qualitative evaluation of a trust-wide digital inclusion programme supporting digitally excluded people using mental health services.

Key messages

  • digitally excluded people using mental health services face barriers related to device access, connectivity and digital skills
  • a trust-wide offer providing devices, data connectivity and one-to-one digital skills support improved access to digital care
  • participants reported increased engagement with services and greater perceived control over their care
  • tailored, individual support was central to building confidence and digital capability
  • digital inclusion was viewed as enabling participation rather than replacing non-digital care options.

Policy implications

  • digital inclusion support should be treated as a core component of digital mental health strategies
  • investment in devices and connectivity needs to be accompanied by personalised skills support
  • mental health providers may need dedicated roles or teams to deliver digital inclusion at scale
  • hybrid models should remain available to avoid excluding those unable or unwilling to use digital tools.

Gaps

  • limited evidence on longer-term outcomes and sustainability
  • no assessment of cost-effectiveness
  • potential selection bias due to voluntary participation
  • uncertainty about scalability beyond a single NHS trust.

Commentary
This study demonstrates how targeted digital inclusion support can improve access and engagement for mental health service users who are otherwise excluded from digital care. By combining devices, connectivity and one-to-one support, the intervention addressed multiple barriers simultaneously.

From a care equity perspective, the findings highlight that digital exclusion is not simply a technical issue but one linked to confidence, skills and control. Supporting people to use technology on their own terms can enhance autonomy and participation in care.

The emphasis on personalised support is particularly important. Standardised digital roll-outs are unlikely to meet the needs of people facing multiple disadvantages, whereas tailored approaches may help reduce inequities in access to mental health services.

However, the study also points to evidence gaps. Without data on long-term outcomes, cost-effectiveness and scalability, it remains unclear how such programmes can be embedded sustainably across systems. Even so, the findings provide useful practice-based evidence for designing more inclusive uses of technology in care.

Austerity and mental health service provision in the UK

An analysis of how austerity-driven funding reductions have affected the capacity, accessibility and delivery of mental health services in the UK.

Key messages

  • austerity-related funding reductions have reduced the capacity of mental health services across the UK
  • access to mental health care has become more uneven, particularly affecting people in low-income or marginalised communities
  • higher thresholds for accessing services have left many individuals with unmet mental health needs
  • workforce pressures and reduced community provision have contributed to increased reliance on hospital-based and crisis services
  • financial constraints have weakened early intervention and preventative mental health programmes.

Policy implications

  • sustained investment in community-based mental health services is needed to reduce reliance on crisis care
  • early intervention and preventative programmes require stable funding to remain effective
  • workforce planning should address shortages created by funding reductions
  • policymakers may need to consider the long-term consequences of austerity policies on mental health outcomes.

Gaps

  • the study focuses on the period following austerity policies and does not examine longer-term trends beyond this context
  • limited quantitative evaluation of how funding reductions directly affect specific outcomes across different populations
  • further research is needed on how austerity impacts vary between regions and service types.

Commentary
This paper examines how austerity policies have reshaped the provision of mental health services in the UK. It shows that reductions in funding have constrained service capacity at a time when demand for mental health support has continued to rise. These pressures have resulted in stricter eligibility thresholds and greater reliance on crisis-based care.

The findings highlight how financial decisions affect the balance between preventative and reactive services. Cuts to early intervention and community support mean that individuals often receive help later, when needs have become more severe. This shift places additional pressure on hospital services and emergency care pathways.

Workforce shortages and reduced investment in community-based support further contribute to this pattern. When services are under-resourced, staff capacity declines and waiting times increase, reinforcing a system that responds to acute crises rather than preventing deterioration in mental health.

In relation to care equity, the study demonstrates how austerity measures can widen existing inequities in access to mental health support. Communities already experiencing socioeconomic disadvantage are more likely to face barriers to timely care, leading to greater reliance on emergency services and poorer long-term outcomes. These dynamics highlight how financial policy decisions can shape not only service availability but also the distribution of care across different populations.

Overall, the paper argues that sustained investment in mental health services, particularly in community-based and preventative approaches, is essential to avoid deepening inequities in access and outcomes.

Mental health emergencies attended by ambulance services in rural England

A study examining mental health-related ambulance callouts in rural England during the COVID-19 pandemic, highlighting differences in presentations and service pressures compared with urban areas.

Key statistics 

  • the study analysed ambulance attendances for mental health emergencies in rural England during the COVID-19 pandemic using routinely collected ambulance service data 
  • people living in rural areas were more likely to present with behavioural disturbance, suicidality and anxiety-related crises compared with people living in urban areas 
  • rural ambulance services experienced longer response times and greater travel distances when responding to mental health emergencies 

Key messages 

  • mental health emergencies attended by ambulance services increased during the COVID-19 pandemic 
  • people living in rural areas were more likely to present with behavioural disturbance, suicidality and anxiety-related crises 
  • rural ambulance services face operational challenges including longer travel distances and response times 
  • limited access to specialist mental health services in rural areas increases reliance on ambulance responses for crisis situations 

Policy implications 

  • strengthen community-based mental health support in rural areas to reduce crisis presentations 
  • improve integration between ambulance services, mental health teams and community services 
  • invest in rural mental health services to reduce reliance on emergency responses 
  • develop targeted crisis response pathways for rural populations 

Gaps  

  • the study focuses on ambulance attendances and does not capture individuals who experienced mental health crises but did not contact emergency services 
  • the analysis is limited to the COVID-19 pandemic period and may not reflect longer-term trends in rural mental health emergencies 
  • the research focuses on ambulance service data and does not include patient outcomes following emergency response 
  • further research is needed to understand how service availability affects crisis presentations in rural communities 

Commentary 
This study examines mental health emergencies attended by ambulance services in rural England during the COVID-19 pandemic. Ambulance services often act as the first point of contact for people experiencing acute mental health crises, particularly when other services are difficult to access. 

The findings show that people attended by ambulances in rural areas were more likely to present with behavioural disturbance, suicidal thoughts or actions, and anxiety-related crises. These types of emergencies often require specialist mental health support, yet access to such services can be more limited in rural areas. 

Rural ambulance services also face practical challenges that differ from urban settings. Longer travel distances, fewer nearby healthcare facilities and limited availability of specialist services can affect response times and the type of support that can be provided during an emergency. 

During the COVID-19 pandemic, many community and mental health services experienced disruption. As a result, ambulance services often became an important entry point into care for people experiencing acute distress. 

From a health and social care equity perspective, the study highlights how geographical location can shape access to crisis support. People living in rural areas may have fewer options for urgent mental health care and may rely more heavily on emergency services. This can place additional pressure on ambulance services and may delay access to specialist support. 

Overall, the findings suggest that improving access to community mental health services and crisis support in rural areas could reduce reliance on emergency responses and help ensure more equitable access to mental health care.