Just a tick-box exercise? A content analysis of Equality Impact Assessments associated with policies for restrictive practices in NHS Mental Health Trusts in England

Widely used in the NHS, Equality Impact Assessments (EIAs) are structured tools used to evaluate whether policies or decisions may negatively impact individuals in relation to ‘protected characteristics’, including age, gender, and ethnicity. EIAs are designed to support compliance with UK equality legislation. However, there are concerns that these are not meaningfully engaged with –including in relation to restrictive interventions in psychiatric hospitals, which are known to be imposed disproportionately on some patient populations. This study employed a three-stage content analysis to examine EIAs associated with seclusion, restraint, and continuous observation policies in NHS Mental Health Trusts in England. A total of 113 in-date documents were obtained, of which 82% had an EIA. However, 70% of the EIAs denied the possibility of the policy having a disproportionate impact on patients in relation to characteristics such as age, gender and ethnicity. The content of most of the documents lacked detail, specificity and clear, tangible actions. However, this is not necessarily a call for more documentation. In isolation, conducting EIAs – or calling for these to be conducted – is insufficient in addressing the harms and injustices associated with coercive and restrictive practices in mental health inpatient settings. More substantial actions and policy change is required.