Michael: racialised perceptions of risk in mental health crisis

Michael: racialised perceptions of risk in mental health crisis

Context

Michael is a 34-year-old Black Afro-Caribbean man who works as a secondary school teaching assistant. He lives with his partner and has no previous history of violence, criminal offending or detention under the Mental Health Act. Michael has recently experienced significant stress following the death of his father, financial pressure and sleep difficulties. Friends describe him as outspoken, passionate and emotionally expressive.

What happened

One evening, neighbours hear Michael speaking loudly during a phone call outside his flat. A neighbour contacts the police, reporting that Michael appears “aggressive” and “out of control”. When officers arrive, Michael is visibly distressed and frustrated. He repeatedly asks why the police have been called and raises his voice when interrupted. Officers interpret his behaviour as threatening. Michael tries to explain that he is grieving and overwhelmed, but officers repeatedly tell him to “Calm down”. A neighbour comments that Michael is “usually intimidating”, although no evidence of violence or threatening behaviour is identified.

As officers move physically closer, Michael becomes increasingly distressed. One officer describes him as “highly agitated and unpredictable”. Michael is handcuffed after pulling his arm away during an attempted search. An ambulance is called and Michael is taken to a hospital place of safety under Section 136 of the Mental Health Act. He repeatedly tells staff: “I’m upset, not dangerous.” At hospital, Michael waits several hours for assessment. Staff record that he is angry, tearful, tired and suspicious of authorities. He expresses frustration about racism and says he feels he is being treated differently because he is a Black man.

During assessment, Michael speaks passionately and loudly. A Mental Health Advanced Nurse Practitioner (ANP) records him as “hostile and potentially paranoid”. His partner tries to explain that Michael is grieving, under stress and has been sleeping poorly, and that he has not behaved violently. Her information is not fully explored. There is no meaningful attempt to gather previous information from his GP or wider support network. Michael is detained under Section 2 for assessment. During admission, he is restrained after refusing medication and staff describe him as non-compliant. He repeatedly says no one is listening to him.

Over the following days, senior clinicians observe no evidence of psychosis and Michael engages appropriately in conversation. Staff recognise that many behaviours interpreted as aggression were linked to distress, grief, fear and mistrust. The detention is discontinued.

Impact

What anti-racist practice should look like

Risk assessment must be culturally informed, trauma-informed and evidence-based. Emotional distress, grief, frustration or fear should not automatically be interpreted as dangerousness. Professionals should actively consider how racial stereotypes can influence perceptions of aggression, risk and non-compliance.

Key learning points

• Emotional distress and grief should not automatically be interpreted as dangerous or threatening behaviour
• Cultural stereotypes can influence police, clinical and organisational judgements about risk
• Professionals must distinguish between agitation, trauma, frustration, fear and mental illness
• Family, partner and GP information should be actively sought and properly considered
• Least restrictive approaches should be prioritised wherever safe and appropriate
• Language such as “hostile”, “non-compliant” or “aggressive” should be evidence-based and used with care
• Anti-racist practice requires reflection on why Black men are more likely to be perceived as threatening or dangerous
• Services must build trust by listening, explaining decisions and acknowledging racism when it is raised.