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Restraints are common across hospitals, schools, and juvenile justice settings. Oversight varies widely.

Black children and adults face disproportionately higher rates of restraint in emergency room settings.

Restraints traumatize, have caused deaths, and can drive patients of color away from care they need.

Families have the right to ask about restraint use and demand alternatives, including peer respite centers.

It was the summer of 2013, and I had just arrived in Haiti as part of a global mental health fellowship—an early-career psychiatrist fresh out of training, there to support community-based mental health services serving a community of 1.3 million people in rural Haiti. Within days of arriving, I was asked to help develop a policy for the use of physical restraints at a hospital.

The head of security showed me the equipment. I stood there looking at the straps, cuffs, and fasteners, and my stomach dropped. I was in a former slave colony, the first Black republic in the world, founded on a revolution against the literal shackling of human beings—60 years before emancipation transpired in the United States. And I was being handed what amounted to a contemporary version of shackles and asked to deploy them in the name of safety and treatment.

The discomfort I felt gave me something I hadn't been able to find in my American medical training: distance. Being an outsider, in a country that was not my own, with a history I could not look away from—it cracked something open. I began to ask a question I had never been permitted to ask in residency: Why are we claiming to seek safety in violence?

Back in the United States, during my intern year several years earlier, I had spent a month working overnight as the lone psychiatrist covering a psychiatric emergency room and inpatient unit. In the middle of the night, calls would come in about agitated patients. And then, almost as a matter of routine, I would be asked to sign off on orders for chemical restraints: injections of sedating medication.

I was a brand-new doctor. Yet I was handed a pen and asked to sign on the dotted line, as if this were simply paperwork. As if putting a needle into a person's body to chemically immobilize them was an administrative task. No one acknowledged that what I was authorizing was violent. It was just what we did. The Joint Commission, a nonprofit organization that accredits medical facilities in the U.S., permits residents to sign these orders after the fact, provided certain stipulations are met. What that policy cannot account for is whether a sleep-deprived, nervous new doctor entering a steep power structure will sign off on business as usual or question whether the person being injected warrants that intervention.

Then came the summer of 2020, several months after George Floyd's murder and the beginning of our country's latest racial reckoning, with thousands taking to the streets and growing calls to defund and abolish the police. I was working in a busy county hospital serving primarily Black and Brown people when a Black child from foster care was brought into the emergency room, already restrained.

They lifted their bound hands into the air and pleaded: "Please don't give me a shot."

The gesture stopped me cold. Hands raised. Sounding eerily similar to the "hands on the wheel" directive Black people often instinctively follow when police pull them over. A child in a hospital, in restraints, performing a clear gesture of surrender—hoping it will be enough to keep them safe.

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That was the moment I decided I would never participate in this practice again.

Haiti, residency, that county hospital in 2020—each one asked me the same question, in a louder voice: Why are we claiming to seek safety in violence?

Physical and chemical restraints are used regularly across psychiatric emergency rooms, inpatient units, residential facilities, and other accredited behavioral healthcare facilities. Regulators, including the Centers for Medicare and Medicaid Services and the Joint Commission, require strict ordering, monitoring, and documentation requirements. They are meant to be an option of last resort for situations in which patients are a danger to themselves or others.

And yet research shows that Black children and adults face a higher risk of physical restraint in emergency department settings compared with white patients. In my own experience working in emergency rooms and inpatient settings where restraint use is a daily, hourly occurrence, the process can be an option of convenience.

The psychological harms run deep. Restraints traumatize. They rupture the therapeutic relationship. I have been told by patients of color that they avoid emergency rooms and hospitals because they do not want to be tied down.

Restraints can be deadly. Daniel Prude, a Black man, died from asphyxiation after being restrained by police and subjected to a spit mask during a psychiatric crisis in 2020. Unlike medical settings subjected to federal oversight, no equivalent standard governs restraint use in schools, by police, or in juvenile justice settings.

A 1998 Hartford Courant investigation documented at least 140 deaths related to restraint use in the prior decade, many of them children. A Hearst Newspapers investigation found that at least 85 children and young people have died after being restrained or secluded in schools, juvenile justice centers, and residential facilities since 1989.

The use of restraints in American psychiatry cannot be separated from the history of slavery. In 1851, Dr. Samuel Cartwright, a prominent Louisiana physician and intellectual, invented drapetomania, a fictitious disease he claimed caused enslaved Black people to run away from their enslavers. The treatment included whipping.

The "safety" being preserved was the institution of slavery itself. When I stood in that storage room in Haiti, I was looking at the descendants of those tools—updated in material, but in my mind, unchanged in function.

The question Haiti handed me has become central to how I practice and what I believe this profession owes the people it serves. My decision to never put someone in restraints again has informed my clinical practice, where I go to great lengths to warn people of its risk during crisis care.

If your child or family member is in psychiatric care, it's important to know that restraints are standard practice in many facilities, and that Black patients face a significantly higher risk of being subjected to it. You have the right to know that restraints are supposed to be a last resort and to ask whether that standard is actually being met. You have the right to seek alternatives to standard psychiatric facilities where restraints are commonplace, including peer respite centers.

The system calls it safety. You are allowed to call it what it is.

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