More coercion, less support: A latent class analysis of post-incident reviews for mental health inpatients exposed to coercive practice

In psychiatric inpatient care, coercive practices (e.g., physical restraint) are strategies employed to support assessment, treatment and safety plans. Their use, however, is associated with physical and psychological harms. Clinical guidelines recommend offering patients a post-incident review to mitigate these harms, yet evidence suggests these are not routine or consistently implemented. Understanding variation in their provision across coercive events and patient groups, is essential for developing effective and equitable post-coercive practice support interventions. This study aimed to identify distinct profiles of coercive practice exposure among mental health inpatients and examine how these profiles, alongside demographic factors, relate to use or omission of post-incident reviews. A cross-sectional, retrospective analysis of three years of anonymised patient incident data (>8,000 incidents, ~1,600 patients) from the centralised electronic incident reporting system of a mental health service provider in England was conducted. Latent class analysis and multinomial regression examined associations between class membership post-incident review occurrence and staff-reported reasons for omission. Latent class analysis identified four profiles: (1) removal/ separation, (2) threat-compliance coercion, (3) passive refusal, and (4) resistive refusal. Profiles were interpreted as differing in relative invasiveness and restrictiveness based on the types and combinations of coercive practices. Post-incident reviews were significantly less likely to occur following more invasive exposures. Black and racially minoritised groups were more frequently represented in profiles less likely to receive a post-incident review. Profile membership also predicted staff-reported reason for omission of post-incident review. Variation in implementation of post-incident reviews in inpatient mental healthcare is influenced by the coercive practice context and demographic factors. Findings suggest that broadening the scope of post-coercive practice support and tailoring it to the specific coercive practice context may enhance patient experience and help address inequities.