An exploratory service evaluation of reported incidents of racism in inpatient mental health wards and a psychiatric intensive care unit (PICU)

Abstract

Prompted by growing concerns about racism in healthcare, particularly towards staff, this mixed-methods service evaluation investigated the frequency, nature, and response to incidents of racism within inpatient mental health settings across an NHS Trust in North-West England. Incident reports from January 2023 to December 2024 were analysed. Quantitative data was used to examine associations between aggression-related racist incidents and factors such as ward type, perpetrator sex, and the victim–perpetrator relationship. Reflexive thematic analysis of incident narratives was conducted to explore how racism is described, understood, and managed in practice. Findings suggest that racist abuse, primarily by patients towards staff, was prevalent in high-acuity settings. Racism was frequently conceptualised as a symptom of mental illness, contributing to ambiguous or minimised documentation. Three key themes were identified: the normalisation of racist abuse, inadequate support for affected staff, and limited intervention for perpetrators. Reports often lacked anti-racist language or clear definitions of discrimination, potentially obscuring the issue. These findings underscore the need for trauma-informed, anti-racist practice and culturally sensitive staff support. Enhanced reporting mechanisms and interventions are recommended to promote psychological safety and equity in mental health care. This evaluation contributes to evidence that responses to racism must extend beyond procedural de-escalation.