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

Martin Locht Pedersen, Frederik Gildberg, John Baker, Janne Brammer Damsgaard, Ellen Tingleff

Research output: Chapter in Book/Report/Conference proceedingConference abstract in proceedingsResearchpeer-review


Background: Little effort has been dedicated to the study of mental health where certain ethnic inpatient groups are reported to receive more restrictive practices than others. Efforts to reduce use of restrictive practices in mental health inpatient settings may benefit from focusing on patient ethnicity and seeking to improve practices for ethnic minorities.

Aim: To summarise extant knowledge about ethnicity and use of manual restraint, mechanical restraint, rapid tranquillisation and seclusion in adult mental health inpatient settings.

Method: A scoping review was conducted using the methodological framework by JBI (1,2). Literature searches were conducted in CINAHL, Embase, PubMed, PsycINFO and Scopus. Additionally, grey searches were conducted in Google, OpenGrey and websites of selected organisations, and in the reference lists of included studies.

Results: 38 studies were included; 34 were primary studies; four, reviews. Use of restrictive practices according to ethnicity was in primary studies reported according to national/migrant status (n=16), mixed categories (n=12), non-indigenous vs. indigenous (n=5), region of origin (n=1), religion (n=1) and sub-categories of indigenous people (n=1). In reviews, ethnicity was not comparable. The categories of restrictive practices in the included studies were seclusion (n=20), multiple restrictive practices investigated concurrently (n=17), mechanical restraint (n=8), rapid tranqullisation (n=7) and manual restraint (n=1).

Discussion: This review shows that ethnic disparities in use of restrictive practices in adult mental health has received some scholarly attention. Evidence suggests that certain ethnic minorities were more likely to receive restrictive practices than others. These findings are in line with extant literature limited to acute/intensive settings where ethnicity is reported as a risk factor frequently associated with use of restrictive practices (3,4). However, this review also shows that the studies were characterised by a lack of consensus and continuity, and both ethnicity and restrictive practices were used with widely differing definitions. Consequently, certain comparisons and synthesis are not possible. Further research in this field may benefit from using greater standardisation.

1. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chaptor 11: scoping reviews (2020 version). In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. Adelaide, Australia: JBI; 2020.
2. Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evidence Implementation. 2021;19(1):3-10. 10.1097/xeb.0000000000000277
3. Beames L, Onwumere J. Risk factors associated with use of coercive practices in adult mental health inpatients: a systematic review. J Psychiatr Ment Health Nurs. 2021. 10.1111/jpm.12757
4. Beghi M, Peroni F, Gabola P, Rossetti A, Cornaggia CM. Prevalence and risk factors for the use of restraint in psychiatry: a systematic review. Rivista di Psichiatria. 2013;48(1):10-22. 10.1708/1228.13611
Original languageEnglish
Title of host publicationHoratio Congress 2023
Place of PublicationMalta
Publication statusAccepted/In press - 2023


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