In England, the Care Quality Commission is responsible for monitoring the way the MHA is used and protecting the interests of patients under the Act. The Commission have observed that between 2005–06 and 2015–16, the reported number of uses of the MHA increased by 40%. They proposed a number of factors that influenced the rates of detention, including the increase in population size and in sections of the population ‘at risk’ of detention, especially older people with dementia. Furthermore, there has been a striking change in policy and practice as a result of the Supreme Court judgment in P and Q and P in Cheshire West and how criteria for detention are now applied to people with dementia. The effect of this has meant that most patients with dementia and who lack the capacity to consent to admission to psychiatric in-patient care are now detained under the MHA. We will therefore give a brief overview of the MHA, especially as it relates to dementia, and other practical applications will be dealt with in more detail in the chapters to follow.

The illegal killing of George Floyd led to Black Lives Matter protests around the world and energised the call for discrimination to be addressed in society. In this chapter we explore evidence of mental health inequalities in those from BAME communities and acknowledge that some groups in society, who may or may not identify as BAME, such as asylum seekers travellers and the LGBTQ+ community, also face discrimination. We mention the theory of intersectionality, racial gaslighting and the detrimental impact of austerity on health outcomes. Readers are reminded of the historical reports into the deaths of Michael Martin, Joseph Watts and David ‘Rocky’ Bennett and of the 2002 Sainsburys Centre review which identified a ‘circle of fear’. The finding of the independent review of the MHA and the recently published rapid review of ethnic health disparities by the NHS Race and Health Observatory are highlighted. NHS England and NHS Improvement’s Advancing Mental Health Equalities Strategy, the RCPsych equality action plan, and The Patient and Carers Race Equalities Framework (PCREF) are explained. Stereotyping of black males and the disproportionate use of force (including tasers), is discussed and the authors call for the implementation of mandatory training covering the nature of discrimination.