UK studies have reported disproportionate detentions of Black and minority ethnic (BME) patients under the Mental Health Act 1983 (MHA). We conducted a systematic review to examine the evidence for greater detention of BME patients within psychiatric services in the UK and to examine evidence offered for these explanations, including racism in psychiatry.

Bibliographic databases were searched, descriptive analyses used to summarise studies and meta-analyses performed to produce pooled odds ratios. Possible sources of heterogeneity were investigated.

Meta-analysis revealed that BME patients were over three times (3.35), Black patients were nearly four times (3.83), and Asian patients are twice as likely (2.06) to be detained as compared to White patients, even when other predictors of detention were controlled. There was a striking lack of primary evidence to support most explanations to account for this excess.

While there is robust evidence that BME status is an independent predictor of psychiatric detention in UK, the causes of this remain unclear. Many potential explanations for greater detention such as length and severity of illness, pre-morbid personality, subjective experiences of receiving psychiatric care, lack of a social support system that can provide alternatives to detention and the relationship between local service structure and detention rates have not been studied. A simple ‘race-based’ explanation has possibly been detrimental to understanding the true reasons behind this excess and need to be explored in better designed studies using mixed qualitative and quantities methods.