Stigma, race, and testimonial injustice in mental health detention: Professionals experience of Compulsory Assessment and Treatment under The Mental Health Act 1983

Leah, Caroline, Dixon, Jeremy ORCID: https://orcid.org/0000-0003-0656-5646, Craig, Elaine, Heyes, Kim, Best, Debbie, Bergqvist, Anna and Haines-Delmont, Alina 2026. Stigma, race, and testimonial injustice in mental health detention: Professionals experience of Compulsory Assessment and Treatment under The Mental Health Act 1983. PLOS Mental Health 3 (3) , e0000567. 10.1371/journal.pmen.0000567

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Abstract

This article examines how stigma, racism, and epistemic injustice shape health and social care professionals’ experiences of Compulsory Assessment and Treatment (CAT) within mental health and policing systems, with particular attention to the racialised experiences of Black men. Despite longstanding recognition of institutional racism and structural inequality, the persistent over‑detention of Black men under mental health legislation remains inadequately addressed. This study advances the field by shifting focus from procedural reform to epistemic critique, analysing how credibility, knowledge, and understanding are unevenly distributed, racialised, and denied within CAT practices. Drawing on a multi‑method Experience-Based Co‑Design (EBCD) study, the article reports qualitative findings from interviews with 13 mental health professionals, an EBCD feedback event, and a co‑design workshop involving 46 participants. Centring experiential knowledge, the analysis applies reflexive thematic methods informed by epistemic injustice, Critical Race Theory, stigma inequality, and the Silences Framework. Three themes are identified: (i) Racial Stereotyping and Risk Assessment, (ii) Stigma and the Denial of Care, and (iii) Race Anxiety and Colour-blind Racism. These findings illustrate how racialised framings within CAT generate both testimonial and hermeneutical injustice, silencing Black men’s voices and rendering their experiences unintelligible within dominant professional paradigms. The analysis makes a significant scholarly and practical contribution by demonstrating that stigma functions as a structural and institutional logic shaping professional decision‑making. Meaningful change therefore requires systemic transformation, rather than a narrow focus on individual professional attitudes. The article calls for greater epistemic openness, urging professionals to recognise the limits of dominant frameworks and to incorporate lived experience and community‑based knowledge into practice. By reframing mental health and policing practices through an epistemic lens, the study identifies a transformative route toward more equitable, accountable, and just systems. Although situated in the UK, the insights have broader relevance for global mental health systems confronting racialised exclusion and structural inequity.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Schools > Social Sciences (Includes Criminology and Education) Research Institutes & Centres > Centre for Adult Social Care Research (CARE)
Publisher:	Public Library of Science
Date of First Compliant Deposit:	18 March 2026
Date of Acceptance:	18 March 2026
Last Modified:	31 Mar 2026 13:29
URI:	https://orca.cardiff.ac.uk/id/eprint/185849

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