Risk factors associated with use of coercive practices in adult mental health inpatients: A systematic review

Abstract

What is known on the subject?• Coercive practices such as restraint (physically holding a person) or seclusion (containing a person in locked room) are frequently used in mental health care.• How often and which specific practices are used is not consistent across different healthcare systems, hospitals or wards.• Internationally, there is agreement on the need to monitor and reduce the use of coercive practices. What this paper adds to existing knowledge?• The reviewed evidence suggests a number of different factors affect a person's risk of experiencing coercive practices, while admitted to a mental health ward.• However, there is currently not enough high-quality research evidence to say which factors are most important or how they work to influence the likelihood of a person experiencing coercive practice. What are the implications for practice?• When carrying out risk assessments, mental health professionals must take into account that a number of different factors are important and explore these with the patient.• Care plans aimed at minimizing the use of coercive practices, such as restraint, must be personalized and developed with the individual.

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

“…Ethnic minorities were significantly more likely to receive seclusion in all but one study, where the inverse association was reported [ 79 ]. However, after adjusted analysis, the reverse association was reported in one further study [ 68 ], whereas associations became non-significant in three studies [ 7 , 59 , 62 ]. In Western Pacific-based studies, ethnic minorities were indigenous (e.g.…”

“…Three studies reported significant associations between ethnicity and rapid tranquillisation [ 7 , 39 , 77 ], of which there was no further description in one study [ 77 ]. Ethnic minorities, in this case people of foreign citizenship (Swiss-based study) or not further described (review study), were significantly more likely to receive rapid tranquillisation in the two remaining studies [ 7 , 39 ]. However, these associations became non-significant after using adjusted analysis, although, proportionally, ethnic minorities were more likely to receive rapid tranquillisation.…”

“…Eight studies reported significant associations between ethnicity and seclusion [ 7 , 9 , 40 , 59 , 62 , 68 , 79 , 80 ]. Ethnic minorities were significantly more likely to receive seclusion in all but one study, where the inverse association was reported [ 79 ].…”

“…Widespread international efforts have been made to improve mental health practice by reducing the use of restrictive practices, such as manual/mechanical restraint, rapid tranquillisation and seclusion [ 1 – 4 ], but, so far, with little success [ 5 , 6 ]. Of concern, ethnic minorities appear to be subject to more restrictive practices than others [ 7 – 10 ]. If mental health practices are to be improved, an enhanced understanding of the relationship between restrictive practices and ethnicity is of crucial importance.…”

“…Outcomes for different ethnic groups are therefore an area of interest when implementing programmes to reduce restrictive practices in mental health [ 10 ]. Several reviews have identified ethnicity as a risk factor frequently associated with restrictive practices [ 7 , 8 ]. However, these reviews were limited to acute/intensive mental health inpatient settings and did not focus on ethnicity specifically but on risk factors generally.…”