One Hundred and Thirty-One Hours

There is no instruction manual for what to do if you or a loved one are having a mental health crisis. Virginians who end up in this position simply have to use the resources available to them and trust that everything will be ok.

But what do you do if that trust is broken?

Nathan[1] was just 19 years old in May 2024. Years before, he had been diagnosed with Autism and Intellectual Disability, and he was living in a group home to make sure his needs were being met. On most days, his life was calm and uneventful.

But one day Nathan began having a mental health emergency. He was acting out and needed help. His family and group home staff used the resources available to them and put their faith in the police.

Law enforcement officers responded and brought Nathan to Richmond Community Hospital (RCH) under an emergency custody order. There, he was held in the emergency department for almost 10 days.

During this time, he was strapped to a bed for over 131 hours, including in his sleep.

Imagine not being allowed to move or get out of bed for five-and-a-half days as your mind spirals and you wait for treatment.

The ER is an overwhelming place to most people, with bright lights and strange people, sound, and food. Nathan isn’t able to communicate very much in words but, considering his Autism and mental health challenges, we can only imagine how terrifying, overstimulating, and overwhelming the ER must have felt.

A clinician assessed Nathan and found that he met the criteria for a temporary detention order. This should have meant transfer to a psychiatric hospital or unit that could give him the mental health care that he needed. But that didn’t happen.

Instead, Nathan spent almost 10 days in the ER, over half of that spent restrained to a bed, because no private hospital would accept him due to his diagnosis. Many private hospitals avoid accepting people with intellectual or developmental disabilities, assuming that the State-operated psychiatric hospitals will “pick up the slack” and handle these “difficult” patients. After all, State Hospitals are considered to be the “Bed of Last Resort” under Virginia Law. But, that week, the State psychiatric hospitals were all full.[2]

According to hospital documentation, Nathan was not violent nor aggressive during his time in the ER. He was sensory seeking. He even tried to calm himself by walking around. But RCH didn’t allow him to self-regulate in this way, instead, they repeatedly chose to restrain him, hour after hour, adding to his distress and creating a sense of mistrust that may last a lifetime.

Unfortunately, Nathan’s story is not an isolated incident. Across Virginia, people with intellectual and developmental disabilities are routinely failed by our crisis response system, which is not designed for their needs.

Restraining a patient out of convenience is not care, nor is it providing treatment. It is traumatizing.

dLCV worked with Nathan’s family to file complaints on his behalf and hold RCH accountable for the laws and trust that they broke. We are committed to eliminating the use of abusive seclusion and mechanical restraint, especially among Virginians with cognitive disabilities. What happened to Nathan should force us to confront what is happening in our local care systems. It is a reminder to healthcare professionals, policymakers, and community leaders that people seeking care, especially those who struggle to communicate their needs, deserve safety, dignity, and compassion. Care should never mean confinement. Restraints must be a last resort, always. And no diagnosis should ever define someone’s humanity.

The disAbility Law Center of Virginia works to protect and advance the rights of people with disabilities through legal advocacy, education, monitoring, and public policy efforts.

[1] Names have been changed to protect anonymity.

[2] According to Bed of Last Resort, if no private hospital will admit a person, then the pre-screener must find a state psychiatric hospital that has a bed available. During this process, the pre-screener has a list of hospitals that they need to call first to ask if they will admit a patient. This is a long and grueling process, particularly for the person experiencing an emergency. At best, this often means delayed treatment and at worst, is what Nathan experienced.