Huge regional variation in the numbers of people subject to the Mental Health Act

11 November 2018

New analysis of NHS Digital data by the charity Rethink Mental Illness reveals huge regional variation in the numbers of people subject to the Mental Health Act – in some areas almost three times the national average. 

Ahead of the Independent Review of the Mental Health Act which is being published next month, campaigners call for urgent reform of the “outdated” Act that disproportionally affects people who are BAME, people from deprived backgrounds and those living in urban areas.  

Six out of the ten areas with the highest rates were in London.  Other areas were Preston, Bury, Blackburn with Darwen and South Tees.

The Mental Health Act is the law in England and Wales which governs when someone can be treated for a mental illness without their consent. Approximately 20,000 people are subject to the Act in any given month, and in the last decade, there has been a 47% increase in detentions.

According to Rethink Mental Illness, the reasons behind the variation will be complex, but factors include deprivation, particularly in urban areas, which impacts on mental health. Most of the areas listed also have a higher proportion of people from BAME backgrounds, who are disproportionately detained under the Act. This is an issue being looked at as part of the Independent Review of the Mental Health Act, led by Sir Simon Wessely. Cuts to local services can also lead to more people reaching crisis point, which is often when the Act comes into force.

The charity says the Act is outdated and in dire need of reform to ensure the many people who come into contact with it are treated with dignity and respect.

Across England, the ten areas (by Clinical commissioning Group) with the highest rate of people subject to the Mental Health Act per 100,000 were (the national average is 36 per 100,000):

  1. Islington – 97.87 people per 100,000
  2. West London – 94.15 people per 100,000
  3. Camden – 90.78 people per 100,000
  4. Central London (Westminster) – 87.33 people per 100,000
  5. Greater Preston – 86.64 people per 100,000
  6. City and Hackney – 84.63 people per 100,000
  7. Bury – 81.74 people per 100,000
  8. South Tees – 77.72 people per 100,000
  9. Ealing – 68.57 people per 100,000
  10. Blackburn with Darwen – 67.22 people per 100,000

Being “subject to” the Mental Health Act includes those who are held under the Act for their own safety or for the safety of others, also known as being “sectioned”. The data also covers those who are living in the community under “Community Treatment Orders” and people who have “conditional discharges” from hospital, for example on the understanding the person takes their medication.

Brian Dow, deputy chief executive at Rethink Mental Illness, said:

“These figures highlight what Theresa May called one of the “burning injustices” in Britain today: that if you are poor, from a black, Asian or minority ethnicity background and live in an urban area, you are much more likely to come into contact with the Mental Health Act if you have mental illness. 

“What concerns us the most is that we have been told by countless people how the Act failed to protect their rights and dignity, how people were excluded from decisions about their own treatment, and carers were left in the dark about what was happening to their loved ones. That is simply not acceptable in Britain in 2018.

“Given how many people are affected, it’s crucial we have a Mental Health Act that works. We urge the government to make reform of this outdated piece of legislation a top priority once the Independent Review of the Act is published next month.”

Case study – more available on request:

“When I was sectioned I was never consulted about medication or even told what drugs they were giving me.  I had a seizure, the first and last I have ever had. I could have died.  It was caused by the cocktail of medication.  But they refused to change my medication.  I was then terrified every time I had an injection that it might happen again but there was always a threat that if I didn’t agree to be injected it would be done by force.

The worst thing was that I shouldn’t have been taking the medication in the first place because I had been misdiagnosed, which I had told doctors but wasn’t believed.  In the end, I just went along with what the psychiatrists said in hospital and simply stopped taking the inappropriate medication when I left. I have been much better since, taking the drug that I know works for me.  More generally there is too much focus on medication instead of therapy.

Often it feels like detaining people is a way for staff to do things quickly without a need to understand the patient and what they need.  With more staff time and a different approach, nurses and doctors could persuade you to take a drug, or understand why you don’t think it will work.  But the law means that they don’t have to do that when someone is being treated under the Mental Health Act. And it means that patients who aren’t being treated under the Act can be seen as awkward, because they can’t be controlled as easily.”


For more information and interviews contact the Rethink Mental Illness media team on 0207 840 3138 or

Notes to editors

About the data

  • NHS digital publishes the number of people subject to the Mental Health Act per clinical commissioning group on a monthly basis as part of its Mental Health Monthly Dataset. This analysis was based on the most recent data August 2018, published November 2018.
  • Rethink Mental Illness analysed NHS Digital Mental Health Act data indicator MHS08 ‘People subject to the Mental Health Act at the end of the reporting period’ which records the number of people subject to the Act in these discrete categories: people subject to detention (otherwise known as being sectioned), people subject to Community Treatment Order or conditional discharge, people subject to short term holding powers, as well as people subject to Guardianship.
  • The Mental Health Act dataset for August 2018 shows how many people were subject to the Act in each of the 195 clinical commissioning groups in England.
  • There were a further 1310 people who were shown as subject to the Act in the data where clinical commissioning group responsibility was unknown.
  • Population data to calculate per 100,000 rate is based on the mid-2017 weighted population estimates for the CCGs, as published by the Office for National Statistics.
  • NHS Digital collects annual detention data. The most recent set records 49,551 detentions as of 2017/18. NHS Digital archive data shows there were 63,600 people detained under the Mental Health Act in 2015/16 compared to 43,400 in 2005/6, representing a rise of 47%. Due to changes in reporting mechanisms since 2015/16, it is not possible to make long-term comparisons with new data published since then.

About Rethink Mental Illness

  • Rethink Mental Illness is a charity that improves the lives of people severely affected by mental illness through local groups and services, expert information and training and successful campaigning.
  • Rethink Mental Illness runs an advice and information service for people who are affected by mental illness. Lines are open 9:30am-4pm Monday to Friday (excluding Bank Holidays) and the number is 0300 5000 927 (calls are charged at local rates) or you can email
  • Together with the charity Mind, Rethink Mental Illness runs Time to Change, a growing movement of people changing how we all think and act about mental health problems.
  • For access to a range of free images to accompany mental health news stories please visit: These images have been developed by Time to Change.
  • For more information go to