Comparing Disparate Application of Physical Restraints on Patients Seeking Emergency Mental Health Care at Two San Francisco Emergency Departments

Bibliographic Data

ID19578335
AuthorsDrake Johnson (University of California, San Francisco), Lizbeth Alvarez (University of California Davis School of Medicine, Davis, California, USA.), L García-Marcos Álvarez (University of California, Davis), Anneka Hooft (0000-0002-9684-419X, University of California, San Francisco), Kenshata Watkins (0000-0002-0814-4477, University of California, San Francisco), Monique LeSarre (University of California, Berkeley), Aude Bouganon (University of California, San Francisco), Veronica Jackson (0000-0001-6663-2762, Rafiki Coalition), Vanessa Jackson (0000-0003-1942-4148, Rafiki Coalition), Toni Hines (Rafiki Coalition), Lillian Agyei (Rafiki Coalition), Shanell Williams (Rafiki Coalition), Rosny Daniel (University of California, San Francisco), Alison Hwong (Stanford Department of Psychiatry and Behavioral Sciences and VA Palo Alto, Palo University of California San Francisco, San Francisco, California, USA.), Alison R Hwong (0000-0002-7443-8019, Palo Alto University), Will Martinez (University of California, San Francisco), Marilyn D Thomas (0000-0003-3245-6363, University of California, San Francisco), Vidya Eswaran (0000-0002-3339-6967, Washington University in St. Louis, corresponding author)
Year2026
Volume10
Publication date2026-01-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Equity (JOURNAL)
Journal identifiersISSN: 2473-1242 • E-ISSN: 2473-1242
PublisherSAGE Publications (PUBLISHER • US)
DOI10.1177/24731242251394114
OpenAlexW7135072138
LanguageEN
References cited31

Introduction: Black patients are more likely to receive physical restraints in both emergency department (ED) and inpatient settings, yet the mechanisms behind these disparities remain unclear. This study aims to assess whether hospital type—academic tertiary care center versus county-funded trauma hospital—drives the association between race and restraint use. Methods: We used a community-based participatory research approach to analyze electronic medical record data from patients seen for a mental health emergency in 2019 and 2020 at two San Francisco hospitals, University of California, San Francisco Parnassus Hospital (UCSF) and Zuckerberg San Francisco General Hospital (ZSFG). Descriptive statistics and chi-square tests assessed patient characteristics by restraint, followed by multivariable logistic regression to estimate associations between race and restraint, stratified by hospital. Results: We identified 6,631 unique encounters, with 1,051 (15.8%) involving physical restraints. At ZSFG ED, 19.2% of patients were restrained, and 12.6% at UCSF ED. In combined adjusted hospital analysis, Black patients had higher odds of restraint (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.16–2.05). Stratified analysis showed significantly higher odds of restraint for Black patients at UCSF ED (aOR 1.77, 95% CI 1.12–2.79), while ZSFG ED showed marginally higher odds of restraint for Black patients (aOR 1.44, 95% CI 0.99–2.09). Discussion: Our findings suggest that hospital type may not significantly influence disparate restraint use in EDs. Further research should explore other potential contributors, including prehospital interactions with emergency services. Health Equity Implications: These results highlight the need for interventions that address the broader impact of structural racism on patients in mental health crises

Confidence interval · Emergency department · Health care · Logistic regression · Mental health · Odds · Odds ratio · Psychological intervention · Automotive and Human Injury Biomechanics · Healthcare Decision-Making and Restraints · Restraint-Related Deaths