Race and Sex Increase Odds of Handcuffing in Behavioral Health Emergency

Race, age, and sex among youth in disadvantaged neighborhoods are associated with increased odds of being handcuffed by law enforcement (LE) when using emergency medical services (EMS) in behavioral health emergencies (BHEs), according to study findings published in JAMA Network Open.

In Alameda County, where this study took place, EMS call protocols specify a response by LE and EMS officers, often with LE arriving first. Researchers sought to uncover whether sex, age, race and ethnicity, and neighborhood disadvantage were associated with youth less than 18 years of age being handcuffed during BHEs.

The researchers conducted a cross-sectional study from January 2012 through June 2019 in Alameda County, California. The primary exposures included Area Deprivation Index (ADI) race and ethnicity. LE handcuffing during BHEs was the primary outcome. The researchers consulted the ALCO EMS pediatric encounters database to inform a matching process between encounters and patient data from regional psychiatric emergency services. Severe BHE was defined as any of: a patient’s immediate transport destination listed as the psychiatric emergency service, the dispatch code indicating severe BHEs, or if the EMS encounter narrative indicated the patient for and involuntary hold.

In the final study sample, there were 10,471 pediatric BHE encounters and 6759 included in final analyses. Of those included, 57.2% involved girls; there was a mean (SD) age of 14.6 (0.02); and 31.3% were Black, 21.6% White, 10.2% Asian, 24.2% Other, and 12.8% Hispanic.

Overall, 7.6% of encounters (517) resulted in LE handcuffing. Compared with White children, Black children had higher odds of being handcuffed during BHE encounters (adjusted odds ratio [aOR], 1.80; 95% CI, 1.39-2.33).

Moderate and high neighborhood disadvantage, compared to the lowest neighborhood disadvantage also resulted in higher odds of LE enforcement handcuffing (moderate ADI aOR, 1.51; 95% CI, 1.21-1.88; high ADI aOR, 1.54; 95% CI, 1.19-1.99). In the neighborhood with the lowest disadvantage, Black children vs. their White peers were still 1.6 times more likely to experience LE handcuffing. Further, in moderately disadvantaged neighborhoods these odds increased by 2.5 (aOR, 2.52; 95% CI, 1.65-3.86). Odds of Asian child handcuffing were less than half compared with White children (aOR, 0.47; 95% CI, 0.29-0.76), though this was only consistent for Asian children.

Increased odds of handcuffing were found in age (aOR per 1-year increase, 1.15; 95% CI, 1.10-1.21) and in boys (aOR, 2.31; 95% CI, 1.91-2.79). When stratified by sex, Black girls had significantly higher odds of handcuffing vs White girls (aOR, 2.59; 95% CI, 1.69-3.98).

While handcuffing prevalence varied by race and neighborhood disadvantage, only handcuffing of Black children vs White children proved statistically significant.

“The findings of this study suggest both Black children and youth in disadvantaged neighborhoods are disproportionately handcuffed when using EMS services for behavioral health emergencies,” the researchers concluded.

Study limitations include the incompleteness of EMS data, selection bias due to significant missing demographic data, and the possibility of undocumented handcuffing occurring with responding LE then handcuffs removed before EMS arrival.

This article originally appeared on Psychiatry Advisor