Short summary

We focus on ethnicity and rapid tranquillisation (RT) use in adult mental health inpatient settings, where ethnic minorities are more likely to receive RT compared to ethnic majority populations. However, evidence relating to forensic services remains limited. We aim to explore the association between ethnicity and RT use within forensic services, and examine whether staff decision-making processes differ when administering RT to individuals from diverse ethnic backgrounds.

Rationale

Ethnic disparities in rapid tranquillisation (RT) use have been reported in adult mental health inpatient settings. Evidence suggests that individuals from ethnic minority backgrounds are about 1.5 times more likely to receive RT than those from ethnic majority backgrounds in these settings. RT is a restrictive practice involving the forcible administration of sedative medication, like antipsychotics or benzodiazepines, to prevent harm to oneself or others. It is the most commonly used restrictive practice in adult mental health care worldwide, with estimates indicating that RT is used in 25.6% of individuals in adult mental health inpatient settings. Despite its widespread use, RT is not recommended as a first-line strategy for managing behavioural disturbances in mental health care, according to leading clinical guidelines. Furthermore, limited evidence exists on the safety and efficacy of specific medications used in RT. RT carries various risks, including polypharmacy, the concurrent use of other restrictive practices, potential harm and serious adverse events, such as drowsiness, hypotension, cardiac arrest and extrapyramidal side effects. Consequently, leading international organisations have advocated for reducing the use of restrictive mental health practices like RT. A key limitation of previous research on ethnicity and RT use in adult mental health inpatient settings is the lack of focus on forensic services, a setting for which little evidence exists on this issue. To explore this knowledge gap, this study aims to profile and compare individuals from different ethnic backgrounds who underwent rapid tranquillisation in adult forensic mental health inpatient settings. Additionally, it seeks to characterise clinical decision-making processes regarding these inpatients.

Description of the cohort

Adults with a forensic mental health measure from Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark.

Data and biological material

Data from registration forms for the Danish Forensic Mental Health Database coupled with data from medical records.

Collaborating researchers and departments

Forensic Mental Health Research Unit Middelfart, University of Southern Denmark

• Prof Frederik Gildberg

Research Unit Children and Adolescent Psychiatry, University of Southern Denmark

• Prof Trine Munk-Olsen

School of Healthcare, University of Leeds

• Prof John Baker