Ethnic Disparities in Clinical Decision-Making for Rapid Tranquillisation in Adult Forensic Mental Health Inpatient Settings: A Qualitative Study.

Rapid tranquillisation is a widely used restrictive practice, but evidence suggests that ethnic minorities are disproportionately exposed compared with majority populations. This retrospective qualitative multiple-case study explored how staff clinical decision-making regarding rapid tranquillisation, as reflected in clinical documentation, may vary by ethnicity in adult forensic mental health inpatient settings. Nineteen cases involving rapid tranquillisation use between 01 Jul 2021 and 31 Jan 2025 were purposively selected using paper-based forensic registration forms and electronic health records. Cases were categorised dichotomously by ethnicity using country of birth (ethnic minorities vs. the majority population), and data from clinical documentation were analysed using content analysis, guided by a four-component framework of clinical decision-making, examining similarities and differences within and between cases. The SRQR standards were used for reporting. Overall patterns of rapid tranquillisation use were broadly similar across groups. However, differences were reported in the temporal unfolding of situations leading to rapid tranquillisation, negotiation and planning processes and the documentation of distress, severity and risk. Escalating distress and behaviour tended to be recognised later among ethnic minorities, often shortly before rapid tranquillisation, whereas escalation among the majority population was more frequently documented over longer periods. Documentation of proactive planning, voluntary medication negotiation and debriefing was limited overall but less visible for ethnic minorities. Clinical decision-making appeared iterative and cyclical, with repeated rapid tranquillisation use occurring across both groups. Ethnicity may influence clinical decision-making regarding rapid tranquillisation, with disparities emerging through cumulative, process-oriented variations in practice. Further research is required to confirm these findings.