Matthew Tuleja, 32, a former Division I college football player, spoke to the annual gathering of the American Psychiatric Association this year, describing how he was slammed to the floor and cuffed to a stretcher in a room in a psych unit that was filled with pepper spray. “His wrists and ankles were cuffed to the sides of a stretcher, and his pants were yanked down. They gave him injections of Haldol, an antipsychotic medication he had repeatedly tried to refuse, as he howled in protest,” writes Ellen Barry for The New York Times.
Forcible restraints are routine events in American hospitals, Barry writes, citing a recent study, using 2017 data from the Centers for Medicare and Medicaid Services, that estimated the number of restraints per year at more than 44,000. (Similar restraints and injections can also be used in the field by paramedics, sometimes in conjunction with police calls. ) Black patients are significantly more likely to be forcibly restrained. In study after study, hospitals have proved that it is possible to reduce the use of coercive force in psychiatry. But it requires sustained effort. It also means balancing patient welfare against the safety concerns of nurses, who are frequently injured in psychiatric settings. De-escalation takes time, and when systems are understaffed, they may default to force as a matter of efficiency.