This October, as we mark Black History Month and 77 years of the NHS, we take time to honour the contributions made by black and racially diverse communities to our mental health services, and to face, with honesty, the inequalities that persist within them.

The fight against racial inequality and inequity in mental health services is a very personal journey for me.

As a service user and carer for decades, I have seen first-hand the devastating impact that systemic racism and injustice has on people’s lives.

I have lost family members to these inequalities. My commitment to this agenda is personal, as well as professional and moral.

The case for change

For too long, the mental health system has failed Black and racially minoritised people.

Review after review, stretching back over 4 decades, has told the same story: harsher, more coercive, and less therapeutic care.

The most recent Mental Health Act statistics (2024/25) show this starkly: people from a Black or Black British background are detained under the Act at rates 4 times higher than white people – an increase from 3.5 times the year before.

These figures are unacceptable.

Hope

Yet even amid this reality, there is hope. One hope lies in the Patient and Carer Race Equality Framework (PCREF).

5 years ago, we started working with 4 committed trusts piloting PCREF. Today, 18 exemplar sites have joined us, leading the change.

And, from April 2025, when PCREF became mandatory, every mental health trust in England has had to embed its principles. That is progress, and it gives me hope.

PCREF is a structural answer to a structural problem. It is the first national, co-produced, governance-ready anti-racism framework for mental health in the NHS, built on 3 pillars:

• Leadership and governance using transparent data.
• 6 organisational competencies, co-produced to drive improvement.
• Patient and carer feedback, measuring lived experience.

Already we have seen progress:

• Ward manager training on NHS England’s culture of care standards is helping staff dismantle inequitable practices while creating safe space to share their own experiences of discrimination.
• At South London and Maudsley NHS Foundation Trust, ethnicity recording rates are now 96% in community services and 99% in inpatient care, enabling fairer, data-led decision-making.
• At Black Country Healthcare NHS Foundation Trust, local people are being recruited as paid PCREF community ambassadors, directly shaping anti-racist mental health services.

This is real, visible progress; but there is still much more to do.

Working together

This work is not happening in isolation. PCREF is central to wider reform, shaping the upcoming Mental Health Bill and development of the Mental Health Act Code of Practice.

The Department of Health and Social Care (DHSC) has described the PCREF as “the single most important lever we have to reduce racial disparities in mental health’’.

Embedding its principles into the Code of Practice will ensure racial equity is not peripheral, but at the very heart of how mental health law is implemented.

NHS England and DHSC are working more closely together than ever to provide clear direction, enabling delivery, and supporting NHS staff across England.

This joint approach ensures tackling racial disparities in mental health is not just a priority today, but a core part of delivering the government’s 10 Year Health Plan, embedding fairness and equity into long-term reform.

A shared ambition

Change has been too long in coming. But through PCREF, accountability, and joint leadership, we now have the tools and momentum to ensure that the next chapter of the NHS’s story is one of fairness, equity, and hope.

This month, we honour the past, but we also look to the future; a future where mental health services are not only equal, but truly equitable, for everyone.

To find out more about me and the significant work we are undertaking on advancing mental health equalities, please take a look on our NHS England website.