From mental health detention to health systems reform: Co-producing policy and practice recommendations with Black men, their communities, and health and social care professionals.

"I can't breathe," is the phrase that has come to symbolise broad forms of systemic suffocation experienced by Black communities within mental health systems. Positioning Black men, within the context of health and social dynamics, involves understanding the unique systemic barriers they face. Using mental health detention as the entry point to explore these systemic issues, this research aimed to understand why Black men are disproportionately detained under Mental Health legislation and why they report more traumatic, coercive experiences than their White counterparts. It then co-produced solutions with Black men, their families, communities, and health and social care professionals. This is the first study to unite over 200 stakeholders to to co-produce policy and practice recommendations for change. The Silences Framework (TSF) was used as the overarching theoretical framework along with Experience-Based Co-Design (EBCD) as the participatory action research method. This paper is novel, as the application of TSF fills an important, theoretical gap in the empirical work on mental health and discrimination. Reflexive thematic analysis and methodological triangulation were used to analyse and synthesise the data including: 1:1 interviews with professionals; focus groups with Black men, family members and Black community pillars; EBCD events and parliamentary symposiums. Three themes: (1) 'Identities Beyond the Mask', (2) 'Re-Humanising Detention', and (3) 'Radical Reform' were co-developed with participants. Findings identify stigma, mistrust, discrimination and institutional racism are at the helm of the problem. Seven policy and practice recommendations were co-created to begin to address institutional injustice in psychiatry and better serve the Black community during mental health crisis. This paper presents an original, first of its kind study, investigating the experiences of community stakeholders and professionals and makes a significant contribution that informs policy makers and professionals working in a wide range of mental health and custodial settings around the world.