Psychiatric Patients Restrained at Sky-High Rates at This L.A. Hospital


From the Los Angeles Times: “When he came home from the hospital, Marcelus Laidler began to wet the bed. His mother noticed he seemed leery, questioning everything she did.

His ankles and wrists bore scars — the result, he said, of repeatedly being strapped to a bed with restraints at Los Angeles General Medical Center.

‘I have nightmares I’m being restrained,’ said Laidler, who has schizophrenia and bipolar disorder. ‘That hospital is like one bad dream after another.’

Hospitals are forbidden under federal law from restraining psychiatric patients except to prevent them from harming themselves or others. Restraints can be used only when other steps have failed and are widely discouraged by psychiatric professionals, seen as a measure of last resort that frays trust and can traumatize patients.

At L.A. General — a public hospital serving some of the poorest and most vulnerable people in the nation’s most populous county — the psychiatric inpatient unit has restrained patients at a higher rate than in any other in California, a Times analysis has found.

Federal records show that over a recent four-year period, L.A. General’s Augustus F. Hawkins Mental Health Center has reported a restraint rate more than 50 times higher than the national average for inpatient psychiatric facilities, ranking it among the highest in the country.

Those numbers doubled between 2020 and 2021 — the latest figures publicly available — even as the statewide average for other inpatient facilities barely increased.

. . . Other large safety net facilities in California and across the country do not use physical restraint at anywhere near the same rates as L.A. General, formerly known as L.A. County-USC Medical Center.

L.A. General psychiatric inpatients were restrained at a rate 10 times higher than at Zuckerberg San Francisco General Hospital, according to The Times’ analysis of data from 2018 to 2021, the most recent year available.

Its restraint rate was also far higher than the two other L.A. County-run hospitals with inpatient psychiatric units — 14 times higher than Olive View-UCLA Medical Center and seven times higher than Harbor-UCLA Medical Center.

‘It doesn’t make sense to me that patients in L.A. are more seriously psychotic and dangerous than patients at a general hospital in San Francisco,’ said USC law professor Elyn Saks, who has studied the use of restraints for decades.”

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  1. My conclusions would be:

    1.- Workers in the mental uncare treatment field can’t predict accurately enough who is going to flee and who is going to behave violently. And as such, danger to other and danger to self is a capricious assessment for most individuals. Or at least relevantly.

    Easier to see when considering probably most restrained persons will neither flee nor behave violently.

    And saying accurately enough in practice means they can’t at all, that’s why they restrain a lot of people and still, there are acts of violence. Arguing it would be worse if not done selectively as now, would be tantamount to saying that by restraining ALL we identified ALL and we prevented ALL. It would be equivalent or identical to using NO JUDGEMENT.

    It shows judgement in these matters is close to useless AND for those restrained who won’t flee nor be dangerous, that uselessness is DAMAGING. Even…

    “You can’t not (sic) restrain these folks,” Freudian slip of the tongue meant, probably, to say: WE can not restrain these folks”, which proves my point. It’s about restraints, not treatment. Treatmen and judgement are close to useless AND harmfull. QED.

    2.- Average psychiatric care does not have an impact on reducing violence in those most likely to be violent: ‘telling you, ‘”I’m going to kill you.’”.

    Because most “dangerous” patients, as per the LA Times report, are not accepted in OTHER hospitals. That’s an admission of FAILURE not of human rights respect.

    Which leads me to the conclusion most OTHER hospitals probably treat people, humans, who are not dangerous except for treatment. Treatment can create danger, and even then, managed “per usual”, without as many restraints.

    3.- Previous CRIMINAL violence, as declared by legal authority, is a stronger, more accurate prediction of DANGER, than psychiatric evaluations alone. And tentatively, psychiatric evaluations of incarcerated populations will be biased by the implicit knowledge of that fact.

    4.- Arguing patients can’t follow the rules and therefore need to be restrained when they don’t follow the rules, actually means the rules imposed can’t be followed, at least in such away that restraints are not needed. Another admission of defeat and/or proor decision making, poor insight and judgement, by those that desing and use the facilities AND the rules.

    Saying it can’t be any other way because these “folks” are special, different, is in itself admiting they can’t be treated without restraints, which is circular reasoning.

    “That’s one of those moments when you’re like, ‘This is why I went into psychiatry.’ These are people with really serious challenges who sometimes just need a lot of patience and a lot of time.” I AM being patient and giving TIME by/to the challenged nature of the claim.

    5.- Apparently neither the LA Times nor Dr. Frances Gill, a third-year psychiatry resident are EFFECTIVELY AWARE HOW AKATHISIA actually looks or feels like. Another failure of training, responsability, teaching AND learning at LA General nonetheless. And apparently at the LA Times. Just the omission of mentioning it makes the “I know/knew” useless, innefective.

    “In recent years, state hospitals have cut back on admitting patients from L.A. County-run hospitals who have been found by civil courts to be a danger to themselves or others, county officials said,” precious statement.

    6.- Following the argument means that sending people considered dangerous thus, will still be a DANGER, wherever they are put. Another failure. And most hospitals admited failure to deal, care, “uncare” for them. Hence it does lend weight to the futility of psychiatric care on bases of “danger to themselves or others”. Even when restrained, since LA General reports lots of staff injuries. Ironically some of them when restraining people. Gotta keep trying…

    7.- Akathisia is unackownledged, unrecognized AND caused in greater numbers and more severe forms at LA General. And since at least 5yrs ago, it is now in a self reinforcing positive feedback loop.

    8.- What they need to “de-escalate”, probably, is the prescription of AKATHISIA inducing medications, not escalate food delivery from outside sources. 80% of akathisia caused attacks actually involve TWO, 2, people SUFFERING it. And food delivery probably, ironically, won’t escalate, escalate up very well…

    Curious note: Some inmates at LA General might be able to follow orders when they come in. Even if they are delivered restrained, they become at some point unrestrained inside, for later to be re-restrained. “My baby got worse. She needs to survive this…”. QED.

    9.- That LA Times piece might be a sutile propaganda actually arguing FOR restraints, not AGAINST them. Just the AKATHISIA omission…

    “her son is being treated as an animal.” not even, I would not treat “even” an animal like they did Mr. Laidler or Miss Anagnostou, so no. And permited the hyperbole, a prized Bull won’t be treated like that, ask any rancher that has one. Values and species of “animals”, in the broadest sense…

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  2. Thanks for all information. i think that the medications need to be assessed, they all can cause side effects and if the individuals that are restrained have akathesia or any anxiety or clostrophobia then restraints make their trauma an unbearable nightmare.
    I think that the error is from polypharmacy. The antipsychotics, antianxiety meds, and antidepressants change the brain and body chemistry sometimes making the person develop additional problems such as diabetes, high or low blood pressure, thyroid and GI issues as well as cognitive and memory decline. I wish peace to all patients who have to endure such trauma. I wish peace and further education to the healthcare staff.

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  3. hello. i left a comment yesterday, however i do not see my comment here today,
    Informative being calm and kind and treating with respect. I was concerned with polypharmacy. Anyone who is on any medication over the counter or prescribed {examples antipsychotics, benzos, antidepressants, gerd meds and others }seems to have a terrible time in responding to the nurses/healthcare workers due to cognitive disorder or oversedation; insomnia etc all play a role in the patient’s physical decline, therefore give less drugs. thanks.

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