Ethnic disparities in the use of restrictive practices in adult mental health inpatient settings: a scoping review

Abstract

Purpose To identify and summarise extant knowledge about patient ethnicity and the use of various types of restrictive practices in adult mental health inpatient settings. Methods A scoping review methodological framework recommended by the JBI was used. A systematic search was conducted in APA PsycINFO, CINAHL with Full Text, Embase, PubMed and Scopus. Additionally, grey literature searches were conducted in Google, OpenGrey and selected websites, and the reference lists of included studies were explored. Results Altogether, 38 studies were included: 34 were primary studies; 4, reviews. The geographical settings were as follows: Europe ( n = 26), Western Pacific ( n = 8), Americas ( n = 3) and South-East Asia ( n = 1). In primary studies, ethnicity was reported according to migrant/national status ( n = 16), mixed categories ( n = 12), indigenous vs. non-indigenous ( n = 5), region of origin ( n = 1), sub-categories of indigenous people ( n = 1) and religion ( n = 1). In reviews, ethnicity was not comparable. The categories of restrictive practices included seclusion, which was widely reported across the studies ( n = 20), multiple restrictive practices studied concurrently ( n = 17), mechanical restraint ( n = 8), rapid tranquillisation ( n = 7) and manual restraint ( n = 1). Conclusions Ethnic disparities in restrictive practice use in adult mental health inpatient settings has received some scholarly attention. Evidence suggests that certain ethnic minorities were more likely to experience restrictive practices than other groups. However, extant research was characterised by a lack of consensus and continuity. Furthermore, widely different definitions of ethnicity and restrictive practices were used, which hampers researchers’ and clinicians’ understanding of the issue. Further research in this field may improve mental health practice. Supplementary Information The online version contains supplementary material available at 10.1007/s00127-022-02387-8.

Nurses' clinical decision‐making in the use of rapid tranquillization in adult mental health inpatient settings: An integrative review

“…As shown in Table 2, research has been conducted mainly in general mental health settings, with only one study from forensic mental health. This distribution of settings was not surprising as it is supported by recent research analysis within restrictive practice use (Baker et al, 2021;Pedersen et al, 2022). However, people in forensic mental health are hospitalized in restrictive settings where the level of conflict and use of restrictive practices may be particularly high (Pedersen, 2020;Völlm & Nedopil, 2016).…”

“…Thus, these factors could either increase or decrease the probability of its use, indicating the risk of using rapid tranquillization without being based on professional clinical judgement. The risk is underpinned by its widespread use (Hu et al, 2019; Muir‐Cochrane, Grimmer, Gerace, et al, 2020; Raboch et al, 2010) and the reported risk factors associated with its use (Beames & Onwumere, 2021; Pedersen et al, 2022). Further research in this field is needed to ensure minimal and safe use and safety for all.…”

“…Nevertheless, most mental health laws accept staff's use of restrictive practices as a last resort in cases of violence and aggression (Maguire et al, 2021; Völlm & Nedopil, 2016) in an attempt to prevent people from harming themselves or others (Pedersen, 2020; Power et al, 2020). While restrictive practices have been investigated and debated for decades, rapid tranquillization seems to have eluded attention and has been studied with varying clarity (Baker et al, 2021; Hu et al, 2019; Muir‐Cochrane, Oster, & Grimmer, 2020; Pedersen et al, 2022). Rapid tranquillization is the coercive administration of acute calming medication, typically by intramuscular injection (National Institute for Health and Care Excellence, 2015; Völlm & Nedopil, 2016).…”

Enhancing research inclusion: The importance of grey literature searches

“…Therefore, the exclusion of grey literature by the authors may have increased the risk of not finding all relevant studies and perspectives on the ethics of care in technology-mediated healthcare practices. As an example of the usefulness of grey literature searches, in a recent scoping review of research literature, nearly 50% of all included studies (16 out of 38) were identified through sources other than bibliographic databases [4].…”

“…However, by lacking grey literature searches, the authors may have biased their findings towards a narrower range of sources. Like others [4], the authors' inclusion criteria focus on English-language literature. However, primarily research conducted in the Scandinavian and Northern American context was included, and the question is whether the topic is so contextspecific, as reported in the study, or whether it is possible to find relevant English-language literature in other contexts through grey sources.…”