Ethnic Disparities as Potential Indicators of Institutional Racism in Inpatient Care within Acute Mental Health Wards: A Rapid Review

Purpose Previous reviews suggest minoritised ethnic patients face inequalities in aspects of inpatient care including involuntary admission and forced medication. This rapid review aimed to identify ethnic disparities in acute adult mental health care and explore to what extent these provide evidence of institutional racism, as defined by the Macpherson report. Methods Ovid MEDLINE, Cochrane Library, Ovid PsycINFO, Web of Science and Ovid EMBASE were searched for studies published from January 2018 to August 2024. Quality of evidence was assessed using the Joanna Briggs Critical Appraisal Tools. A synthesis of the studies was performed. Results Quantitative studies (n=34) revealed ethnic disparities in involuntary admission, psychiatric diagnoses, forced medication, physical restraint, seclusion, length of stay and access to appropriate services/facilities. Qualitative data (n=2) revealed experiences of disempowerment, confusion and loss of autonomy. Collectively these findings mapped onto components identified as underlying institutional racism as defined by the Macpherson report. Conclusion Our current evidence can be used to understand the genesis and perpetuation of insitutional racism in health care settings. This will enable us to better target intervention or change management to address issues where they arise. Further research and analyses are needed however, in order to verify whether ethnic disparities in inpatient services and treatment reflect or are themselves exacerbated or contributed to by institutional racism.