Patient ethnicity and staff use of restraints and restrictive practice in inpatient psychiatric services: a systematic review

O'Collins, Max; Dening, Tom; Chou, Shihning

Abstract

Background: Restrictive practices such as restraints, seclusion and forced medication are only intended to be used when threat is at a level whereby an individual is likely to inflict harm on themselves or another individual. Demographic variations, including ethnicity, may be associated the use of these practices. However, there is no systematic review on patient ethnicity specifically. The review therefore aimed to establish whether a patient’s ethnic identity were associated with staff use of restrictive practices in inpatient psychiatric services.

Method: The systematic review followed the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) guidelines. Four databases were searched (PsycINFO, Medline, Embase and CINAHL). Methodological quality was assessed using the Critical Appraisal Skills Programme Checklists.

Results: Fifteen studies met the inclusion criteria. A variety of ethnicities were identified within the studies. These were driven by the location of the study. Seclusion (14 studies), forced medication (4) and physical restraint (4) were explored. There were mixed findings, with ethnicity shown to predict restrictive practices in some studies.

Discussion: The current evidence seems to be varied. It remains unclear whether ethnicity is a genuinely independent predictor of restraint and coercive practices or interacts with other risk factors. Staff working in inpatient settings should be aware of how unconscious biases might affect clinical practice. Recruiting a diverse workforce from minority ethnic groups into inpatient psychiatric services would be a positive step. However, support for these staff members is important, and all staff should be equipped to respond to ethnic diversity.

Citation

O'Collins, M., Dening, T., & Chou, S. (in press). Patient ethnicity and staff use of restraints and restrictive practice in inpatient psychiatric services: a systematic review. Trauma, Violence, and Abuse,

• Journal Article Type: Article
• Acceptance Date: Jun 18, 2025
• Deposit Date: Jul 22, 2025
• Journal: Trauma, Violence, and Abuse
• Print ISSN: 1524-8380
• Electronic ISSN: 1552-8324
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Keywords: ethnicity, restraint, restrictive practice, seclusion, systematic review, mental health
• Public URL: https://nottingham-repository.worktribe.com/output/51888383
• Publisher URL: https://journals.sagepub.com/home/tva