Minority patients are more likely to receive rapid tranquillisation
A new study from the University of Southern Denmark, recently published in BMJ Mental Health, reveals that patients from ethnic minorities admitted to adult mental health wards are 49% more likely to undergo rapid tranquillisation compared to those from the ethnic majority. The reasons for this disparity remain unclear to researchers.
Rapid tranquillisation is a restrictive intervention used to manage patients experiencing severe agitation. It is employed when healthcare staff are unable to calm the patient using other, less intrusive methods.
Minority and majority ethnic groups
Ethnic minority: Refers to individuals belonging to an ethnic group that is a minority in the country or region where they live.
Ethnic majority: Refers to individuals belonging to the ethnic group that forms the majority in the country or region where they live. In Denmark, this typically refers to people with cultural and historical ties to Denmark and Danish culture.
– Previous studies have suggested that ethnicity plays a role in whether patients are administered rapid tranquillisation. With our study, we have demonstrated a significant likelihood that patients from ethnic minority backgrounds are more likely to experience this form of intervention, says Martin Locht Pedersen, PhD student at the Department of Regional Health Research and the Forensic Mental Health Research Unit in Middelfart. He adds:
– We found that patients from ethnic minority backgrounds admitted to adult mental health wards are almost 1.5 times more likely to be subjected to rapid tranquillisation compared to patients from ethnic majority backgrounds.
Globally, around 10% of adults with mental health disorders receive rapid tranquillisation during the course of their illness. For those admitted to mental health wards, the figure rises to 25.6%.
Coercive treatment and rapid tranquilisation
Coercive treatment: Includes measures such as forced medication. It can only be applied if the individual meets the criteria for compulsory hospitalisation. This means the person must be suffering from severe mental illness and either pose a danger to themselves or others, or have a critical need for treatment that makes it unsafe not to intervene.
Rapid tranquillisation: Can also be administered to patients who are not severely mentally ill if a doctor determines it is necessary to manage extreme agitation, such as restlessness or anxiety.
Severe mental illness: An umbrella term for a range of serious mental health conditions where an individual’s perception of reality is impaired. Symptoms may include hallucinations, paranoid thoughts, and confusion.
Consent: In general, treatment must always be based on the patient’s consent. However, there are situations where a patient may be unable to provide consent.
The Danish Mental Health Act: In Denmark, both coercive treatment and rapid tranquillisation are regulated under the Mental Health Act. This ensures that specific criteria must be met, and a medical assessment is required before implementation.
Last resort: Should only be used as a last resort. Efforts must first be made to calm the patient verbally or offer voluntary medication.
– Rapid tranquillisation can be a highly distressing and intrusive experience for the patient, as well as for staff, family members, and other patients. This is why it is so important to have tried all other options first. Being subjected to coercion can lead to trauma, explains Martin Locht Pedersen.
Ole Schjerning, a consultant at the Middelfart Psychiatric Hospital, is one of the professionals responsible for making decisions about rapid tranquillisation. He elaborates:
– On the other hand, it can also be deeply distressing for a patient to experience severe anxiety or agitation. In some cases, dangerous situations can arise if the patient cannot be calmed. Here, rapid tranquillisation may be less intrusive than, for instance, physical restraint.
The Need to Understand the Disparity
The 糖果派对 study highlights that individuals from ethnic minority backgrounds are more frequently subjected to rapid tranquillisation in adult mental health wards compared to those from ethnic majority groups. However, the study does not provide clearly explanations for this ethnic disparity, which needs further investigation.
– There could be several explanations for the difference. Perhaps patients are more unwell before they come into contact with the healthcare system. Alternatively, cultural differences in emotional expression might lead us to interpret their behaviour as signs of distress or severe agitation, says Ole Schjerning.
Both Ole Schjerning and Martin Locht Pedersen agree that it is positive this disparity is gaining attention.
– We need to account for patients’ cultural and ethnic differences and their perspectives on health and illness. As healthcare professionals, we need to learn more and remain critically aware of the power imbalance that exists between patients and staff, says Martin Locht Pedersen.
He stresses the need for further research in this area, with the goal of promoting equality in healthcare and reducing the use of rapid tranquillisation. This study forms the first part of his PhD, with the remainder dedicated to exploring the subject further.
About the Study
The study included a systematic review and meta-analysis of 15 international studies, encompassing a total of 38,622 individuals. It does not specifically address a Danish context but builds on findings from prior research. A 2020 report from the Danish Institute for Human Rights showed that restrictive interventions are used 45% more often on non-Western immigrants than ethnic Danes.
The study found a 49% higher likelihood of rapid tranquillisation for individuals from ethnic minority backgrounds. In practical terms, this means that for every one person in the ethnic majority group who receives rapid tranquillisation, the likelihood is 1.5 times higher for an ethnic minority patient.
Read the study:
The study, Ethnic disparities in rapid tranquillisation use and justifications in adult mental health inpatient settings: a systematic review and meta-analysis, is
Meet the researcher
Martin Locht Pedersen is a PhD student at the Forensic Mental Health Research Unit in Middelfart, the Department of Regional Health Research, 糖果派对, and Mental Health Services in the Region of Southern Denmark.