Institutional Racism and its impact on the Mentally Vulnerable

BAME deaths in police custody

The disproportionality in the use of force against Black people adds to the irrefutable evidence of structural racism embedded in policing practices.

Deborah Coles, Director of INQUEST

Institutional racism, a pervasive and systemic issue, casts a long shadow over various sectors in the UK, notably within the National Health Service (NHS) and the criminal justice system.

This deep-seated problem not only undermines the principles of equality and justice but also disproportionately affects the mentally vulnerable from minority backgrounds, often leading to their criminalization rather than receiving the care they need.

This blog post aims to shed light on the complexities of institutional racism within the NHS, its historical context, and the dire consequences for those who fall through the safety nets designed to protect them.

The Genesis of Recognition

The concept of institutional racism gained significant attention in the UK following the publication of the Macpherson Report in 1999, which investigated the murder of Stephen Lawrence.

This report accused the Metropolitan Police of institutional racism and highlighted the systemic failures that allowed racial prejudices to influence its operations.

The report's findings illuminated the systemic failures and prejudices that allowed Lawrence's killers to evade justice for years, marking a turning point in the public and governmental acknowledgment of institutional racism.

This acknowledgment sparked a broader conversation about the presence of institutional racism in other sectors, including healthcare.

Other high-profile cases like the deaths of Mark Duggan and Sean Rigg have underscored systemic racism within UK policing, prompting national discourse and calls for reform.

Historical Context and Notable Cases

From the Brixton Riots of the 1980s, which highlighted racial tensions and police brutality, to the more recent Windrush scandal, the UK's struggle with institutional racism spans decades.

Each event, report, and subsequent reform illuminates the enduring nature of systemic biases and the ongoing battle for racial equality.

Over the years, several high-profile cases have underscored the systemic nature of racism within UK institutions. In healthcare, the disparities in treatment outcomes, access to services, and the experiences of minority staff within the NHS have been well-documented.

Reports such as "The Snowy White Peaks of the NHS" finds that the Black and Minority Ethnic population is largely excluded from senior positions with in the NHS.

Other investigations into mental health care offer a glimpse into the institutional biases that pervade the system. Such as that BME individuals face a higher likelihood of death in police custody or following contact with police, especially where mental health issues are involved or where force is used. Significantly, data suggest that the proportion of BME deaths in custody where mental health issues are a feature is nearly two times greater than in other deaths in custody. This suggests systemic issues in handling mental health crises among BME populations, potentially reflecting broader systemic issues within institutions like the NHS (Inquest, Full Fact, Institute of Race Relations).

Analysis by INQUEST shows a concerning trend over the years, with a significant number of BME deaths in police custody and following police contact in England and Wales. This includes cases where individuals were experiencing a mental health crisis and were not provided with the medical care needed, sometimes resulting in the use of undue force. The Independent review of deaths and serious incidents in police custody by Dame Elish Angiolini QC, commissioned by Theresa May, highlighted the need for action in tackling discrimination, particularly noting the disproportionate number of deaths among people from BAME groups following restraint and the presence of systemic racism (Inquest).

These findings, while specific to police custody, shed light on broader systemic challenges that BME individuals might also face within healthcare settings like the NHS, especially in terms of reporting and addressing racism. The reluctance or refusal to acknowledge race as an issue, minimizing the harm of racist behaviors, and a lack of empathy toward BME individuals are significant barriers to equity and justice, underscoring the importance of acknowledging and addressing institutional racism across all sectors, including healthcare.

"Too Hot to Handle"

The recent NHS report, "Too Hot to Handle," offers a critical examination of institutional racism within the healthcare system and its impact on staff and patient care. Key findings from the report include:

A significant percentage of NHS staff from minority backgrounds report experiencing discrimination at work, affecting their well-being and professional growth.

The report highlights a culture of silence and fear among minority staff, who often feel that raising concerns about racism could jeopardize their careers.

"Too Hot To Handle: An Investigation Into Racism In The NHS" calls for urgent systemic changes within the NHS to address these issues, recommending policies that promote diversity, equity, and inclusion at all levels.

The narrative of institutional racism is punctuated by high-profile cases that have underscored its systemic nature within UK policing. The deaths of Mark Duggan in 2011 and Sean Rigg in 2008, among others, raised poignant questions about police conduct, racial profiling, and the mechanisms in place for accountability. These cases, often accompanied by public outcry and resulting in inquiries or reviews, have not only spotlighted the racial disparities inherent in police actions but have also propelled discussions on the need for systemic reform across the broader criminal justice system.

Statistical Gaze into Institutional Racism

Empirical data sheds light on the extent of institutional racism. For instance, the Home Office's statistics reveal that Black, Asian, and Minority Ethnic (BAME) individuals are disproportionately targeted in stop-and-search operations by the police, a practice that has long been criticized for its racial bias.

The Lammy Review, an independent review conducted by David Lammy MP, further highlighted these disparities, particularly in the sentencing and treatment of BAME individuals within the criminal justice system, underscoring the pervasive nature of systemic biases.

• Minority ethnic groups report poorer experiences in patient care compared to their White British counterparts.

• Staff from minority backgrounds are less likely to be in senior positions within the NHS, despite equal qualifications and capabilities.

• BAME individuals are more likely to be detained under the Mental Health Act in the UK, highlighting disparities in mental health care.

Impact on the Mentally Vulnerable

The intersection of mental health issues and racial discrimination creates a precarious situation for minority individuals. Institutional racism within the NHS and broader societal structures often leads to the criminalization of mentally vulnerable individuals from these communities. Instead of receiving appropriate mental health care, many find themselves navigating the criminal justice system, a pathway fraught with challenges and devoid of the necessary support.

Efforts Towards Change

Recognizing the deep-rooted nature of institutional racism, there have been efforts within the NHS to address these disparities. Initiatives aimed at improving diversity and inclusion, enhancing cultural competence among healthcare professionals, and implementing policies to ensure equitable care for all are steps in the right direction. However, the effectiveness of these measures is continually debated, with calls for more systemic and transformative changes to uproot the biases entrenched within the system.

The Road Ahead

The journey to dismantle institutional racism within the NHS and prevent the criminalization of the mentally vulnerable is complex and challenging. It requires a multifaceted approach that includes policy reform, education, and a commitment to equity at all levels of healthcare provision. By acknowledging the past and present realities of institutional racism, there is hope for creating a more inclusive and equitable healthcare system.


Institutional racism in the NHS is a critical issue that demands attention and action. Its impact on the mentally vulnerable, particularly those from minority backgrounds, underscores the urgent need for systemic change. As we move forward, it is imperative that we continue to challenge these injustices, advocate for the rights of all individuals to receive compassionate and equitable care, and work tirelessly to ensure that no one falls through the safety nets of our society.

Further Reading and Resources:

Macpherson report: what was it and what impact did it have?

Head of Britain’s police chiefs says force ‘institutionally racist’

"The Snowy White Peaks of the NHS" report

Too Hot To Handle: An Investigation Into Racism In The NHS

Final thought

If the following are some of the key findings related to NHS workplace institutional racism, imagine the deadly consequences of extrapolating this to the context of a mentally vulnerable person from a minority background, who has fallen through the safety net of NHS mental healthcare due to institutional racism, and then find themselves in police custody, under the care of an institutionally racist police force.

1. Main reasons for not reporting incidents of racism: disbelief in change and fear of being labelled as a troublemaker.

2. Only a small percentage of concerns being satisfactorily addressed.

3. Common outcomes of reporting race discrimination: inaction and disciplinary actions against reporters.

4. High percentage of respondents leaving their jobs due to poor treatment.

5. Typical responses to raising concerns about race equality: denial, reluctance to acknowledge race as an issue, minimizing harm, and lack of empathy.

6. Challenges in race-related investigations: high bar for proving allegations and avoidance of tackling racism.