Black children face far higher restraint and police-involvement risk in psychiatric crises.

Protecting a child during mental healthcare sometimes means working outside standard protocol, not within it.

Institutional harm can come from credentialed colleagues, not just distant systems outside of mental health.

BEAM's "Psychiatric Green Book" puts survival knowledge directly in Black families' hands.

A young boy was "refusing" to get out of bed and "refusing" to go to school. In the past, this kind of "school avoidance" had meant the emergency room. He had already been there several times, for suicidal ideation and for running away from school.

As his child psychiatrist, I was certain that if he went this time, he would be restrained. Like many of the children I've seen, he was mildly autistic, hypersensitive, his nervous system already in overdrive. The sights and sounds of an ER would only escalate him further, and his distress would be misread as aggression.

By then, I had seen enough Black children like him—distorted and terrorized by the mental health system to know that a single restraint could alter the entire trajectory of a life. Their greater risk of being restrained compared to white children wasn't just a statistic to me.

I explained the risks to his caretakers and asked for their permission to work closely together to keep him at home. They agreed, and we stayed in close contact, assessing, reassessing, and developing a plan together. We also worked on making school a more welcoming space.

I told him he had a choice—the ER, or home—but if he chose home, he had to work toward returning to school by Monday, and talk to........

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