NHS doctors are under pressure not to section psychotic black patients to avoid appearing racist.

The Telegraph has uncovered numerous examples of NHS policy documents and mental health bodies calling for detentions of black people to be reduced to tackle inequality.

Doctors have criticised the policies as "scientific illiteracy" and "jumping on bandwagons".

Nine current and former NHS psychiatrists reported being encouraged to limit the number of black patients they section under the Mental Health Act to avoid them being over-represented.

Black people are 3.5 times more likely to be detained by mental health services than white people. In response to this, the NHS has rolled out positive discrimination policies.

However, doctors warned that higher rates were not the result of a racist mental health system, but linked to risk factors such as social disadvantage, living circumstances and migration.

Psychiatrists said restrictions on sectioning mentally ill black patients deprived them of the care they needed and increased the risk to themselves and the wider public.

One former NHS doctor said: "Once a patient has psychosis, we shouldn't perform sociology, we should perform medicine."

The issue of race and sectioning has come under intense scrutiny during the Nottingham Inquiry into Valdo Calocane's killing of students Barnaby Webber and Grace O'Malley-Kumar, both aged 19, and caretaker Ian Coates, 65, in June 2023.

Calocane, a paranoid schizophrenic, had repeatedly refused medication but was not sectioned after a previous violent incident by mental health workers who cited the "over-representation of black men" in custody.

A former doctor who worked at the same trust where Valdo Calocane was treated said the watchdog visited his hospital ward shortly before the Nottingham killer's attack and he was told there were too many black patients.

The 2018 independent review of the Mental Health Act states that "trying to find ways of reducing compulsory admissions of black African and Caribbean people in particular is one of the main challenges for the review".

NHS England in 2023 advised that trusts look at mental health admissions and "over time should be able to demonstrate reduced inequalities".

The Equalities and Human Rights Commission, which was consulted on the 2025 Mental Health Act, said NHS trusts should be required to provide a "comprehensive action plan if they cannot demonstrate a year-on-year reduction in disproportionate detention rates experienced by ethnic minority groups, particularly black people".

It also said the Care Quality Commission "should monitor local detention rates as part of their inspections, with an expectation of a reduction in disproportionate rates".

Doctors' decisions questioned

A former NHS psychiatrist reported that team members questioned his decisions to section black patients on multiple occasions, warning it could be "construed as racism".

The former head of a major London trust recalled arguing with an inspector over why the majority of the patients on his acute ward were young black men even though the hospital was located in a majority black area.

Several doctors compared the issue to the grooming gangs scandal, in which police in Rotherham failed to stop groups of mainly south Asian men systematically abusing mostly white working-class teenagers amid fear of being accused of racism.

Last year, Mind, the mental health charity, condemned racial disparities in detention as "shameful".

When the new Mental Health Act became law in December 2025, Wes Streeting, the former health secretary, said it would help tackle "unacceptable disparities that have seen black people detained at disproportionately high rates".

However, doctors argued the term over-representation is "morally loaded", and pointed to numerous factors that contribute to high rates of black detentions besides NHS racism, including family breakdown, school exclusion, absent fatherhood, social deprivation and cannabis use.

Prof Sir Robin Murray, one of the world's leading researchers in psychosis at King's College London, said there is "political pressure" to reduce the number of black people being sectioned, but added the reality is that physical and mental health issues affect racial groups differently.

"It's akin to saying that it's very unfortunate that so many black patients are having treatment for prostate cancer, so we should decrease the number having operations," he told The Telegraph. "Black people have an increased risk of sickle cell anaemia and prostate cancer: we're not saying urologists are racist."

Peter Carter, the former chief executive of the Central and North West London Mental Health NHS Trust, said that choosing not to detain black mental health patients because of their race is "indefensible" and "racist", and that clinicians "must be held to account".

Lord Sewell, who chaired the 2020 Commission on Race and Ethnic Disparities, told The Telegraph that UK public health research had been "captured by American critical race theory" and activists peddling "urban myths" about the treatment of black men.

Senior psychiatrists warned that such policies put pressure on doctors to avoid sectioning black patients in order to fulfil Diversity, Equity and Inclusion (DEI) objectives.

A former doctor at Nottingham University Hospitals NHS Trust said the CQC visited his secure ward shortly before Calocane's killing spree.

The doctor said the visitor stood on the ward, which housed 20 patients, all of whom had committed serious offences. The CQC representative, the medic recalled, privately said words to the effect of: "We all know half of these people shouldn't be here. You're doing wrong keeping these people locked up, and that goes particularly for the black patients."

Following the killings, the CQC said opportunities to stop Calocane were missed.

The doctor said: "I thought, 'gosh, that's surprising.'"

A CQC spokesman said: "We do not recognise these comments as being made by any representative of CQC, and find it entirely implausible that a CQC employee would tell NHS staff, in relation to patients on a secure ward, that they were 'doing wrong keeping these people locked up'."

Another NHS psychiatrist described how a colleague accused him of "crossing a Rubicon" when he suggested sectioning a psychotic black patient.

A former London NHS trust chief recalled offering to show members of the Mental Health Act Commission, the former watchdog, his patients' case notes when they questioned why most of the people under detention on his 18-bed locked ward were young black men.

The doctor said he explained that calling them an ethnic "minority" was a misnomer because the majority of people in the borough were black.

For others, the pressure is a more subtle "sotto voce" or "background hum".

"It's a pervasive pressure," said one senior psychiatry professor. "You are seen as failing a little bit if you admit a black person on a section, whereas if you admit a white person it's clear they are very very ill and needed it."

A retired psychiatry professor said there was a "lazy assumption" that psychiatrists were racist when in fact "we're a profession of woolly-minded liberals".

"There is this constant statement that 'we must get the numbers down,'" he added. "My argument is that these people are ill and therefore should be getting more care, not less."

Much of the difficulty stems from the fact that the root causes of psychotic disorders remain unclear.

Swaran Singh, an NHS consultant and professor of psychiatry at Warwick University, said: "Diseases do not spread themselves equally. They are related to risk factors."

Prof Singh said he was branded persona non grata by the profession 20 years ago when he published a paper claiming that detentions of black men were not the result of a racist mental health system.

Rather, he argued, they were linked to risk factors such as urban upbringing, social exclusions, childhood trauma and poverty, to which ethnic minority populations are more susceptible.

He also claimed that "every good study" shows that migrants have higher rates of psychosis than indigenous populations, regardless of ethnicity.

One retired psychiatrist said: "When I was training we had a lot of [sectioned] Irish patients. Nobody said we were locking them up disproportionately."

The 2018 review of the Mental Health Act said there is a "lack of cultural awareness in staff and a need for culturally appropriate care", which has been used by NHS Trusts to explain high rates of black detentions.

However, one former NHS doctor pointed out "there's no evidence that black and brown psychiatrists commit people less often than white psychiatrists", suggesting cultural misunderstanding doesn't play a role in decision making.

One possible explanation is that black people are significantly less likely to seek mental health treatment and tend to present to services at a later stage when symptoms have progressed.

NHS data show that 8.2 per cent of black people receive treatment for common mental health conditions, compared with 18.4 per cent of white British people.

Black patients are also more likely to present to mental health services following contact with police, placing them in crisis-driven pathways for which emergency detention is more likely.

A major source of contention in the debate over race and sectioning is consumption of cannabis, particularly skunk – a highly potent version of the drug sold in the UK – which can lead to psychosis.

Prof Murray said: "Sadly in the Caribbean population in the UK, cannabis consumption is a contributory factor."

Another psychiatrist added: "It doesn't cause schizophrenia but by God it makes it worse."

There is also broad variation between ethnic minorities, with those of Indian and Chinese heritage less likely to be sectioned than white British people.

One psychiatry professor said blaming racism for disproportionate sectioning rates was a "poison in the system" that hampers research into the true causes of the condition and creates a vicious cycle, further exacerbating mistrust of mental health services among ethnic minorities.

'Denying their need for treatment'

An epidemiology professor said that attributing high rates of sectioning entirely to NHS racism is "highly risky" and "doesn't pass the sniff test".

"Attributing all inequalities in psychosis to institutional racism is very dangerous because if you are denying a public health issue within a group in this country, you risk denying their need for treatment," he said.

Another psychiatrist added: "When people make these bold claims that we should reduce the detention levels, I think they need to ask themselves the question: 'Does that mean they are not going to provide treatment for those who actually need it?'"

Frustrated doctors said that DEI had become an "industry" within psychiatry, with all mental health trusts employing diversity leads who they claimed had a financial incentive to make allegations of racism in sectioning decisions.

Lord Sewell said: "For too long we have listened to race activists who have said that black men are being locked up because the system is racist.

"The reality is that these community orders are often short term and has given many young men a new lease of life. We don't hear these stories, only a negative narrative of a system staked against black men."

Prof Singh said: "People should be treated based on what their clinical needs are, rather than what their race is.

"A diagnosis of serious mental illness should not become a shield that allows people to repeat offences just because they have a mental illness.

"This requires serious rethinking about how the criminal justice system interacts with mental health services."

NHS England was approached for comment.

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