Ethnicity and the use of restrictive practices in mental health inpatient settings: a scoping review

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

Aims: To identify and summarise existing knowledge about patient ethnicity and use of manual restraint, mechanical restraint, rapid tranquillisation and seclusion in adult mental health inpatient settings.

Methods: A scoping review was conducted using the methodological framework recommended by Arksey and O’Malley (2005), Levac and colleagues (2010) and the JBI (2020). The Reporting Checklist for Scoping Reviews (PRISMA-ScR) was used for reporting the findings. A systematic search was conducted in APA PsycINFO, CINAHL with Full Text, Embase, PubMed and Scopus. Additionally, grey searches were conducted in Google, OpenGrey and selected websites, and the reference lists of included studies were reviewed. Covidence was used to screen and select relevant studies. Data were extracted using a charting table.

Results: A two-fold analysis process described by Arksey and O'Malley (2005) was adopted, first summarising study characteristics. Afterwards, the use of four different types of restrictive practice in relation to reported ethnicity was analysed. Altogether 38 studies were reviewed; 34 were primary studies; four, reviews. The geographical settings were as follows: Europe (n=26), Western Pacific (n=8), Northern America (n=3) and 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 tranqullisation (n=7) and manual restraint (n=1).

Conclusions: Ethnic disparities in use of restrictive practices 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. Extant research is characterised by a lack of consensus and continuity. Furthermore, widely different definitions of ethnicity and restrictive practices are used. Further research in this field may improve mental health practice.