The Detention of Black People under the Mental Health Act - Renée Aleong

Jeremy Dixon interviews Renée Aleong about her research on the detention of Black people - and the overrepresentation of Black Men - under the Mental Health Act, as well as sharing the opinions and anecdotes of AMHPS (Approved Mental Health Professionals) involved within these processes.

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Transcript

ExChange Wales

Welcome to the Exchange Wales Podcast, a series that explores research and practice sharing evidence and experience to build better social care in Wales and beyond.

Jeremy Dixon

Hello. Welcome to The Exchange Podcast. My name's Jeremy Dixon. I'm a reader in social work at the Centre for Adult Social Care Research and also a member of Exchange. I'm really pleased to be joined today by Renée Aleong. Renée is someone who has recently done a PhD, looking at the issue of Black people detained under the Mental Health Act, and she's looked particularly at the role of approved mental health professionals.

So welcome, Renée. Really good to see you here. 

Renée Aleong

Thanks, Jeremy. 

Jeremy Dixon

So can you just start by introducing yourself and telling me a bit about your role and what you do? 

Renée Aleong

Sure. No problem. As Jeremy said, hi to all your listeners. I'm a registered social worker, and I'm also a social researcher. My PhD explored how approved mental health professionals make decisions to detain people.

And in particular, we looked at, the issue of disproportionate detention under the Mental health Act of people from Black ethnic groups. My research used, an institutional ethnographic approach to trace how AMHP's day to day work is shaped by legislation, policy and organisational processes. And apart from that, I'm also, a panel member for the National Institute of Health Research, based in King's College in London as well.

Jeremy Dixon

Great. Thank you. Sounds like you're busy.

Renée Aleong

Yes.

Jeremy Dixon

So if we start off just by talking about the, approved mental health professional role. So, so approved mental health professionals, they’re known in short, as AMHPs, as a lot of our listeners will know who are working in sort of mental health services. I guess some people might be more familiar with the role of AMHPs and others.

Jeremy Dixon

So can you just begin maybe by explaining a bit about what the AMHP does?

Renée Aleong

No problem Jeremy. So the role of the approved mental health professional or the AMHP is one of the most powerful and sort of ethically demanding in social work. 97% of AMHPs are social workers. There are other professions such as occupational, therapists, that are also AMHPs but the majority, the bulk of the AMHP workforce are social workers.

And under the Mental Health Act 1983 and amended in 2007, AMHPs coordinate assessments when someone may need compulsory admission to hospital for mental health treatment. So although doctors provide medical recommendations usually to doctors under sections two of the Mental Health Act, it is the AMHP who makes the application for detention on behalf of, you know, the local authority.

And that decision, Jeremy, carries legal weight and moral consequences sometimes. So AMHPs must weigh up the risk to the person and to others against the person's right to liberty, as well. And they follow the code of practice. And obviously the Mental Health Act sort of are the frameworks that support AMHP work. And then AMHPs also, the legislation sort of emphasises that detention should only be used as a last resort, and that every assessment should reflect the principle of the least restriction.

So the least restrictive option. So that idea that, you know, AMHPs or the professionals must always consider the least intrusive option consistent with safe and effective practice. So it's really a nuanced rule, and it's kind of sits outside of the sort of medical sort of model of what we call mental health. So the AMHPs ought to make that decision about the social perspective and the least restrictive option.

So those are the two, you know, the two main sort of areas that AMHP will focus on when it comes to detention under the Mental Health Act.

Jeremy Dixon

Yeah. No. Great. Thank you. And at the beginning of the, recording, you were talking about, Black people being detained more often than other groups under the Mental Health Act.

And, as some people will know already, I think that this is something which has been picked up in policy quite a lot. But could you talk us through that a bit more? So how long has this been a kind of concern that the, disproportionate detention of Black people.

Renée Aleong

Yeah, sure. So, yes. Yes. Jeremy, this is one of the longest standing and most troubling inequalities in British mental health.

The overrepresentation of black men, in particular, detained compulsory detained by section three of the Mental Health Act, which we normally call it ‘sectioning’, you know, when someone is sectioned, was first noted decades ago and has remained consistent in the data. So we have lots of government reviews, such as Inside Out, that was in 2003, we had the Census, which was done by the C2C, in 2011, we had the Wesley Review, most recently that was also called a modernising the Mental Health Act in 2018.

And all of these reports highlighted that Black people, particularly of African and Caribbean heritage, are several times three or more times more likely to be detained or to come into contact with services through police or crisis routes, and to experience less access to early community based support. And these reports largely agreed on the causes of that as well.

So they noted things like structural, racism, socio economic inequality and sort of institutional, mistrust, and sometimes racism and discrimination. And they pointed on the impact also of poverty, housing insecurity, unemployment and discrimination within the mental health system as well. Yet despite this consistent, sort of report, the solutions proposed were mainly behavioural rather than structural.

We didn't go to the sort of the root causes of why this disproportion, exists for many, many decades. But yes, it's one of the, it's sort of the basis of my research and why I wanted to delve deeper into the subject matter.

Jeremy Dixon

Sure. So that's an interesting point, you mentioned about the solutions which are posed are often behavioural rather than structural.

But can you maybe unpack that a bit and just explain what you mean by that?

Renée Aleong

Sure. So my research, when I say behavioural, these initiatives that were given to sort of answer the question of disproportionality was always more focused on how we define risk and how decisions are recorded and how services are resourced and they stay the same.

So even the Wesley review, the Modernising Mental Health Act, two decades on, you know, we still find Black people are overrepresented, at every stage of the Mental Health Act pathway. So, yeah, when we say looking at structures I found in my research, we found that we needed to explore things like the socioeconomic factors that affect people's mental health.

So why are some groups, so it was wider than just detentions under the Mental Health Act. We needed to step a little further back to ask why are certain groups more, likely to be mentally unwell later on in life? And that took me back to looking at those socioeconomic factors such as education attainment, housing, poverty, experience of trauma, employment, your employment status, those things we found those-

they were clear within the literature, clear socio economic indicators of poor mental health. And when we looked at that, we found that people from Black ethnic groups sort of ticked a lot of those boxes, which meant certain groups in society were more susceptible to poor mental health. So it just took me way back then, just looking at detention rates under the Mental Health Act to the causal factors of poor mental health.

So that's why we we talk about structure, you know.

Jeremy Dixon

So that's a really interesting point. So in essence, you're saying that there's a danger in having too narrow a focus on this issue.

Renée Aleong

Yes.

Jeremy Dixon

And there's a need to, to think about a lot of these things that we often think about as social workers, which are the, you know, the structural things

Renée Aleong

Yeah, yeah.

Jeremy Dixon

that tend to make people more likely to be mentally unwell.

Renée Aleong

Mentally unwell. Yes.

Jeremy Dixon

Yeah. And you mentioned the Wesley review, so just maybe a bit of an explanation for listeners. So this was the independent review of the Mental Health Act, wasn't it, which,

Renée Aleong

Yes.

Jeremy Dixon

Then act as a kind of platform for the current mental health bill, which is, going through Parliament as we speak.

And we're having a conversation in October 2025. So, yeah. And that's still happening at the moment isn’t it.

Renée Aleong

Yes it is.

Jeremy Dixon

Okay. So going back to your research questions that you did for your PhD. Can you tell us a bit about, the kind of questions you were asking or looking at when you were doing your study?

Renée Aleong

Sure. So obviously, as we said before, I wanted to look beyond just, you know, why people were detained, disproportionately under the Mental Health Act. And because my research participants were social worker AMHPs, my method sort of, complemented my research question. So I use a method called an institutional ethnography, which looked more at the processes of getting there to the end result.

So my questions were sort of looking at to what extent the accounts of social work AMHPs actual experiences of coordinating a Mental Health Act assessment, looking at Black service users, actually representative of what actually happens because we know we have theories, we have frameworks, we have policies. But I wanted to get into what actually happens. So I spoke to AMHPs about, talk me through a typical Mental Health Act assessment.

We know what's on paper, but I want the actualities and that's what an institutional ethnography does. I also looked specifically at, when AMHPs applied the least restrictive option or looked at the social perspective. What factors influenced the decision to either detain or not detain? And were there any sort of context or nuances in particular for Black people or Black service users there?

So I looked at two things: talk me through - forget what's written on paper - talk me through what actually happens when you, when someone has acute mental distress and you’re called to do a Mental Health Act assessment. Give me what actually happens. And then secondly, when you need to apply that least restrictive option and look at that social perspective, not the medical, not the medical diagnosis, what happens?

Talk me through that as well. Is there anything different for certain groups, you know, are there any factors that are unaccounted for? So that is what we, you know, the crux of what an institutional ethnography was about.

Jeremy Dixon

Okay. So I guess not all listeners might be familiar with that term ‘ethnography’, so what would ethnographers normally do?

What would they be trying to do?

Renée Aleong

So a typical ethnographer, not an institutional ethnography, I’ll explain the difference. So an ethnographer would submerge themselves in a culture, you know, if you were doing an ethnography, you will go into a particular culture, you will learn the language. You might eat the food. You might just learn a lot about about the people and how they live and what makes them who they are, you know?

But with an institutional ethnography, it's similar but it's looking at institutional processes. So it's not focused on the AMHPs, the person themselves. It's focused on the things that the person relies on to make their decisions. So what are the policies? What are the frameworks? What are the texts you use? What mediates your work? You know, so that is what an institutional ethnography is about, it's less focused on an individual AMHP, but more focused on what supports you in making these decisions.

What are the relationship within multidisciplinary teams? What, you know, how does a doctor, a section 12 doctor influence these decisions? So it's less looking at individual AMHPs but more looking at the processes, the part of the system that the AMHP operates in and seeing what we call if there are any disjunctures. So what is different in reality, as opposed to what's written as, you know, written in policies and papers?

And so I looked at any anomalies that might come up, which was very interesting, Jeremy, because as you know, we all have a job description

Jeremy Dixon

Yeah.

Renée Aleong

that you see, you do A, B, C, but if I ask you in reality, tell me how your day actually goes. I know your job description, you’re a reader of social work, but there may be a lot of things that are hidden work that lies within that job description.

So, you know, so that's what an institutional ethnography gets to see. Raise the lid on the unseen work, that sort of hidden work there.

Jeremy Dixon

Sure and it sounds like from what you were doing, you were doing, interviews with the approved mental health professionals, but,

Renée Aleong

Yes.

Jeremy Dixon

having read your study, I think you're also then looking at the policy documents, which you kind of talked about then as well.

So were are you looking at- was it just national policy documents or was it also, what was happening in the local authorities.

Renée Aleong

Sure. So within as an institutional ethnographies, we have something called boss texts and those were the texts that actually mediated work. So when I'm doing an interview with AMHPS, I just ask them, so what, where, you mentioned this, where does that policy sit?

Where does that instruction sit? So some things were at a local level, but I found there were very limited boss texts with, when I spoke to AMHPs and the thing about boss texts, they are key in organising documents that shape practice. So statutes, regulations, policy, frameworks and the forms that professionals complete. So what forms?

They are called boss texts because they hold authority even when no one is consciously referring to them. So they hold a certain power, but no one really understands that. And central to my study, the boss texts that AMHPS told me, they referred to, of course, the Mental Health Act and the Mental Health Act Code of Practice, and of course, a suite of official Mental Health Act forms that they would fill up.

And I also examined risk assessment tools, which were really, really important local authority guidance and case management system. So we spoke about all these sort of frameworks that sit in the background but do impact decision making. And what these texts have in common is that they codify what counts as legitimate reasoning. For instance, the official forms are structured around legal and medical categories: diagnosis, risk, treatment with only limited space for that social context.

Jeremy Dixon

Yeah.

Renée Aleong

So yeah.

Jeremy Dixon

Okay. So that's really interesting. So because of the kind of ways we can think about assessment, both in the kind of pink forms, they’re pink for people who've never seen them. And also, you know, risk assessments, you kind of squeeze out certain things which you,

Renée Aleong

Yes.

Jeremy Dixon

you might wish to consider otherwise.

Renée Aleong

Yeah. So when I followed how AMHPs completed these documents, I saw how narratives mirrored the legal medical logic of the act and they detailed risk meticulously but summarised social circumstances in 1 or 2 lines. And for Black men in particular, this is particularly significant because many of the structural factors driving crises, mental health crises such as poverty, racism, policing, community mistrust sit precisely in that social space that is least visible in that record.

And I must add here as well, Jeremy, the Mental Health Act code of practice reinforces this imbalance. While this least restrictive option or the least restriction appears 30 plus times within the Act itself when they talk about the least restrictive option, the word socialist perspective appears only once in the code of practice. And that's when you're defining what an AMHP rule is.

So it's mentioned once. So an AMHP will take the social perspective. It's not mentioned ever again in that code of practice. So that textual silence is powerful. And it tells AMHPs and other practitioners what matters to the institution. So that was really important for me to see when I was examining the social perspective that wasn't clearly defined within the code of practice that AMHPs have to follow, or there's a major part of their role.

Jeremy Dixon

Yeah. No, that's a really helpful thing to think through, I think, and, to notice. And actually, I guess we commonly use those kind of pieces of guidance or legislation and often aren’t conscious of those things are, you know, it remains at a subconscious level.

Renée Aleong

Sure. So yes, there are major knowledge gaps. I think, when we reframe our work around these texts, the documentation privilege, what is quantifiable.

So risk scores, medical inputs and that sidelines what is relational or structural. Because it's all in this particular form. So until I think texts evolve to require evidence on social considerations, even the most reflective AMHPs I think would struggle. And they would be working uphill against, a paper system or a computer system that reproduces very narrow ways of seeing and knowing.

You know, it's just limited to the documents that you have. So texts are really powerful. But we don't normally, we're not normally conscious of them.

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Jeremy Dixon

Okay, well, we'll get into how AMHPs sort of thought about those texts in a second. But just before we do, very quickly, can you tell us a bit about the kind of context - So I know you did research in two local authorities.

Renée Aleong

Sure.

Jeremy Dixon

Can you tell us a bit about them? I know you can't give us their names because of confidentiality, but just give us a bit of background detail.

Renée Aleong

Oh, no problem at all Jeremy, so I carried out my fieldwork in two contrasting local authorities. Both were urban with both with quite a few demographic and structural contexts. So the first local authority had a large and highly diverse population with significant areas of deprivation and a long history of mental health inequalities linked to poverty, racial segregation and policing practices.

The second local authority was smaller and more compact, with pockets of diversity but a different community layout and service configuration. And while both areas were urban, the first had a much higher proportion of Black people and longstanding community concerns about overpolicing and mental health detention, whereas the second local authority had a smaller, Black and minority population and more integrated community services.

A practical but important difference between the two local authorities is how they manage conveyance as well. And I’ll just explain quickly that is how a person is transported to hospital following a Mental Health Act assessment and detention. So under the Mental Health Act, once an application for detention is made, the person must be conveyed or taken to hospital, which is also specified under the Act.

And this might sound like a straightforward logistical step, but it's actually one of the most distressing and ethically charged parts of the process, particularly for the person being detained and their family members. Then the second local authority, there was a dedicated mental health conveyance service, usually staffed by trained professionals who understood sensitivities at the Mental Health Act and worked within the Mental Health Act.

And this meant that transportation and that sort of logistics could happen in a calm plan and trauma informed way. And AMHPs describe this as a huge asset. By contrast, the first local authority AMHPs had to rely on ambulance services, to provide conveyance, which ambulances are, of course, primarily designed and staffed for medical emergencies such as heart attacks and strokes and what have you.

And this meant that people experiencing acute mental distress, were often deprioritised and sometimes are waiting hours after detention papers were signed. Many, many hours. So I'm just saying that those were some of the nuances and distinctions between those two sort of local authorities. But it was quite interesting.

Jeremy Dixon

Yeah. Okay. So let's pick up on some of the interviews with AMHPs and what they told you about their practice.

Renée Aleong

Sure.

Jeremy Dixon

So one of the things that you just spoken about, was about sort of least restriction. So that's a phrase which is used

Renée Aleong

Yes.

Jeremy Dixon

in the Mental Health Act, guidance. And as you, you know, helpfully kind of explained, the idea is that you should be only detaining people if they absolutely need to be detained.

So if you can kind of treat them at home or whatever, then obviously that's something you should be trying to do. So when AMHPs were using that phrase or thinking about it, how do they interpret it?

Renée Aleong

So I think, there was a lot of mention about risk. So risk was the gravitational centre of AMHP work, Jeremy, every process, form and discussion seemed to orbit around it, orbit around this word, this notion of risk.

And under the Mental Health Act, detention decisions rest on evidence of risk. Risk to yourself, risk to others. And usually risk, risk of harm to, yeah, to self or others. And that's legally necessary. But what I found is that the way in which risk is constructed is deeply shaped by institutional history and cultural assumptions. Right.

So we spoke at length about risk and AMHPs rarely began assessments from a blank slate, as you know, referrals arrived with risk already sort of framed, a GP letter, for instance. The crisis team summary or police report, let's say, I don't know how people come to the attention of AMHPs.

Jeremy Dixon

Yeah.

Renée Aleong

And historical records as well carry labels, of risks such as aggression, aggressive, non-compliant, resistant to treatment.

Renée Aleong

And I found for Black men in particular, those labels echoed the wider sort of societal stereotypes of being dangerous and AMHPs were aware of this. But admitted it was difficult to unpick it in the moment because, as you know, AMHP work is sort of short, sharp, you know, someone is in acute mental distress, especially when decisions must be defensible.

Renée Aleong

So AMHPs relied a lot on past notes where risk assessment was already done. So several participants describe a tension between that actual risk and perceived risk. And some consciously sought out family members or friends to check that narrative. Others said that organisational pressures meant that they had to err on the side of caution, and that often equated to sometimes people being detained.

So my research, using an institutional ethnography, helped me to see how this isn't simply about personal prejudice. It's systemic. You know, when you rely on risk flags and risk indicators and the requirement for defensible decisions, the format of risk templates within the system, the boxes that you tick and cultures within organisation all push practice towards overestimating risk sometimes.

And for racialised groups that compounds the problem of over surveillance.

Jeremy Dixon

Yeah. I mean how aware do you think AMHPs were of those issues that you raised? So, I mean, it sounds like some of them had some awareness and were maybe pushing back?

Renée Aleong

Yeah.

Jeremy Dixon

But was that always the case, do you think, did you notice a difference in participants?

Renée Aleong

Yeah, they were definitely examples of resistance. Some AMHPs described slowing the process down, visiting twice or involving community, you know, community figures. So people outside, you know that social, looking at that social perspective, you know, going to whether it's your church community, other extended family members and these small acts of professional curiosity, as we mentioned, as we call it in social work and relational engagement, often led to different outcomes, Jeremy. And it shows that critical awareness of social and social imagination, I will call it, can counterbalance institutional gravity, but only if time, you know, to support, if you allow the time to support that sort of relational work in social work. So yeah, definitely AMHPs did push back and not just take what was said before in terms of risk, assigning risk and risk flags, but again, not in all circumstances time, time allowed it. It's a very pressurised environment.

Jeremy Dixon

Yeah.

Renée Aleong

And we need time and space to ask additional questions and to allow for professional curiosity. So it's quite a balancing act as you would imagine.

Jeremy Dixon

Yeah. Okay. So just to pick up on another phrase which is used.

Renée Aleong

Yes.

Jeremy Dixon

You know, quite commonly, so there's a phrase about interviewing people in a suitable manner, which was picked up by, approved mental health professionals.

So can you just maybe start by saying where that phrase comes from?

Renée Aleong

Sure. I mean, I could frame it in that, you know, the term non engagement came up in almost every interview I did with AMHPs. And it's often described as a person who's refusing to speak or not cooperating. But when you dig deeper, it reflects much broader issues

in terms of like where you interview people, interviewing people in a suitable manner, as you said, as you know, under section 136, I know that's changing now. So section 136 for those who aren't aware, it's when there's police involvement. So someone may be picked up, in acute mental distress, probably on the streets.

And you're taken to what is called a place of safety and up until now, a place of safety could have been in a police cell. Right. So. And then the police will alert the AMHP that a Mental Health Act assessment is necessary. But obviously looking at, a suitable interview and in a suitable manner, most AMHPs said obviously and now we know that prison cells in particular for, Black men who, you know, who mistrusting of the police, mistrusting of bad trauma, let's say with police before, that was not, you know, a suitable place to be interviewed.

But looking at Black men in particular. So previous experiences with services, especially police involvement, as I said, have left deep scars and sometimes trauma. And by that time when an AMHP arrives, the encounter already carries symbolic weight. If you're going to interview someone in a prison cell, let's say. And it informs, you have, you know, you're conscious of authority, surveillance, and people tend to be silent and withdraw.

And it can be a form of self-protection rather than showing pathology, so that people kind of say if you're not engaging, that's part of the pathology, that's part of the symptoms of what is going wrong with the person. So interviewing in a suitable manner was very nuanced

Jeremy Dixon

Yeah.

Renée Aleong

Jeremy. And how that was interpreted was, you know, case by case.

Jeremy Dixon

You know, that's an interesting point, actually, because I think, that's maybe something that's not thought about so often. So, yeah, I guess, you know, the police may be involved in a couple of ways, you know, sometimes people can be taken to the police station, because that can be seen as what's known as a place of safety, isn't it?

Jeremy Dixon

Within the act? Or sometimes people can be taken to special wards, which are also

Renée Aleong

Exactly.

Jeremy Dixon

you know, identified as a place of safety. But I guess if the police are involved, people might then see that as a police process. So not speaking, like you say, can be not wanting to get, you know, charged with something.

Renée Aleong

Exactly.

Jeremy Dixon

People might not understand it's a mental health process.

Renée Aleong

So just go a little deeper into that. So the code of practice, as you rightly said, requires that interviews be conducted in a suitable manner, but offers little guidance on what suitable means in practice. And I found that for many AMHPs they interpreted it as you said. Some AMHPs interpreted it as environmental. So finding a quiet place or ensuring privacy, whereas other AMHPs extended it to relational work.

Renée Aleong

So using interpreters, involving family or spending more time. So again things are not defined. So my reflection is what suitable must also mean a culturally suitable and historically aware environment. So understanding the legacy of course, in fact psychiatry for instance and racial profiling changes how we interpret behaviour. And what might appear as non engagement could actually be a reasonable response to structural mistrust for instance.

Renée Aleong

So recognising that shift and power dynamic and it opens up again for more humane possibilities for, for engagement and AMHP work so is not suitable can mean different things in different contexts to different people, as I said, but it's not clearly defined in the code of practice. It's just something that we say a suitable environment or suitable place.

Jeremy Dixon

Sure okay, so one issue that was raised by AMHPs was the lack of representation of Black people in the workforce. So, so what did AMHPs themselves think about this?

Renée Aleong

Sure. Jeremy. So this was a strong and recurring theme in my research across both of the local authority. So I interviewed 31 AMHPs across two local authorities, and the majority of AMHPs were White because that's how the workforce is made up.

But Black AMHPs describe feeling both proud and burdened by their visibility, as though they were expected to act as cultural interpreters or advocates for every racialised issue. I find that sometimes, because, yeah, you share a cultural identity. So several AMHPs said they were informally, allocated to assessments involving Black service users, sometimes, because colleagues assumed that they would connect better. While intended positively,

this also risked tokenism and emotional fatigue as well. White AMHPs meanwhile, often acknowledge feeling anxious about race, and some spoke about wanting to to get it right, but fearing that they may say the wrong thing. And that discomfort I think Jeremy, if left unaddressed, can silence learning and lead to avoidance of the topic altogether. So I think White AMHPs were really afraid if they miss-stepped.

So I would say for both groups, you know, White and Black AMHPS, or Ethnic Minoritised AMHPS, they recognise the need for structural and cultural change and not just diversity in numbers. And they suggested a few things, they suggested, like targeted recruitment to make AMHP workforces more reflective of the communities they serve. So that was it, it’s about making your services more reflective of your communities.

So you have that sort of cultural identity. Also anti-racist supervision, ongoing reflective spaces to explore how race and power shape everyday judgements. And I think representation does matter because it shapes both insight and confidence as well. But representation alone isn't enough. It's just not enough to just recruit more, more Black AMHPS. I think organisations and local authorities must also create psychologically safe environments where issues of race and bias can be openly discussed.

It doesn't matter who discusses it, otherwise that emotional labour of diversity falls disproportionately again on those already minoritised. And I could say that as a Black social worker, that it can become sort of yeah, when you’re looked at as the experts in your, in your sort of race and your lived experience, it does become emotionally laborious after a while.

So the conversation needs to be opened up to all social workers, all AMHPS need to be aware of it. So, I mean, the AMHP role is grounded in social justice and human rights, Jeremy. And offers a strong foundation for that reflection, that's part of the rule. But I think it requires sustained institutional commitment and not just goodwill or recruiting more, more Black AMHPs. That wouldn't solve the problem.

Jeremy Dixon

Yeah. No, that's, really clear. I mean, I think, one thing just maybe for us to finish off on is that, the mental health bill is being looked at now and, you know, kind of final changes are being made. And I guess the code of practice is going to be redeveloped in the next year or so.

Renée Aleong

Yes.

Jeremy Dixon

If you are wanting to see a change in practice for Black people who are being detained or being assessed rather and possibly detained under the Mental Health Act, what kinds of things would you want to see? What things might make a difference from your point of view?

Renée Aleong

I believe, as we touched on earlier, Jeremy, I think we need to make the social perspective and least restriction principles enforceable rather than aspirational.

I think the code of practice should require AMHPs to document how they considered alternatives to detention, what those alternatives are and why they were deemed unavailable or inappropriate. I think without that accountability, it's impossible to evaluate whether detention was genuinely the last resort. I also think policy. So looking wider than the actual code of practice and the Mental Health Act Bill, I think policy also needs to tackle the social determinants of mental health.

I think without going back, as we said earlier. So poverty, unemployment, discrimination and housing insecurity, these are not background issues. They're central to why people reach crisis. My literature review highlighted that areas with high deprivation and policing intensity correlate strongly with higher rates of detention around Black men, in particular, when we looked at Keating 2019 [...] et al 2018.

So unless we address the root causes, we’re just managing symptoms downstream, right. So I think we need to take a step back, from the code of practice and the actual act itself. I think at a local level, AMHP services and local authorities can introduce anti-racist supervision, create community partnerships and faith based organisations to build trust and alternative pathways within these communities.

And again, defined what is the least restriction? Define what is the social perspective a bit more you know, for transparency and just share data. I think publishing anonymised data on detentions by ethnicity, as well as the outcome can drive local accountability, because I found AMHPs were quite detached from how their decisions sort of impacted at a local level.

We get the broad national statistics, but no one is aware at a local level about detention and re-detention rates or there's no follow up, you know, AMHPs don't follow up.

Jeremy Dixon

Yeah.

Renée Aleong

Once you pass over to the sort of medical model, once you're in hospital, the AMHPs job is done, but there's no triangulation there, you know, about decisions.

Jeremy Dixon

So there might be a need for kind of better data, which looks at what happens to people over a longer period of time.

Renée Aleong

Yes. Yeah. And use that to inform. I'm not saying that AMHPs need to be, you know, need to be affected by, like an information overload. But I think if we kind of triangulate it and make it more at a local level, people can see how their practice kind of impacts people's mental health journey.

And I think it's about sharing data and collecting data more robustly, especially for groups that are disproportionately detained. So if we’re looking at specific groups. But I still think, this idea of disproportionate detention doesn't start at the Act. I think it starts at attainment at school levels and is much broader, you know, than just the Mental Health Act or the code of practice.

I think we need to look at poverty. We need to look at the experience of trauma. We need to look at employment, housing, all these things that are the social determinants of mental health, it’s structural.

Jeremy Dixon

Brilliant. Well thank you very much for coming in today, Renée. It's been really nice to hear from you. And, yeah, hopefully we'll speak again in the in the not too distant future.

Renée Aleong

Thank you for having me. I hope this conversation helps to spark reflection and, to make change, not just with, practice, but across a wider mental health system. The issues we've discussed, I think, Jeremy, are very complex. And they're not just, you know, it's not just about the Act itself. I think by embedding social understanding and cultural humility, I think we can all come as a community and see that as each one of us has a role, and it doesn't just stop at the AMHP or the section 12 doctor or the social worker.

It's structural. It's how we act with each other within our own communities.

Jeremy Dixon

Brilliant. Thanks, Renée.

Renée Aleong

Thank you.

ExChange Wales

Thank you for tuning in to this episode of the Exchange Wales Podcast. At Exchange Wales, we connect researchers, practitioners and people with lived experience to share evidence, practice and insights that shape social care. Our work spans children's and adult social care, and we're also exploring the growing role of artificial intelligence in the sector.

If you'd like to learn more or get involved, please visit exchangewales.org