‘I don’t think there’s many British African Caribbean men that talk positively about mental health services’: Risk, trust, racism and the Mental Health Act

Detention under mental health law is based on professional assessments of risk but impacts on patients’ trust. Little attention has been paid by sociologists to the operation of risk, trust and racism during mental health detention processes. Our study addresses this gap through thirteen qualitative interviews with professionals, conducted in England in 2023 focusing on the mental health detention of British African Caribbean men: a group disproportionately detained. Data were analysed using thematic analysis and the SILENCES framework. Participant accounts highlighted mistrust between British African Caribbean men and mental health services. This group’s mental health was seen to be affected at a macro level by poverty, drug misuse and racism, as well as cultural mistrust and bias. Negative assumptions of British African Caribbean men were seen to operate at a meso level through institutional practices within risk management processes that discriminated against them, leading to coercive treatments and poorer outcomes. Micro level factors were largely absent from interviews. Participants stressed the need to rebuild trust with British African Caribbean communities, but the strategies they described overlooked the macro and meso factors identified elsewhere within interviews. The article is significant in highlighting cultural drivers of (mis)trust between mental health services and British African Caribbean men at macro and meso levels.