Imagine this scenario

Anti-Black racism and bias toward clients

David is a 35. He is a Black forensic patient who has come to the hospital due to feeling and expressing increased paranoia while in his community. Historically, he would have been admitted briefly until he stabilized, and then he would be discharged.

During this admission, his outpatient team recommends detaining him for longer than usual. They say this is because of “ongoing challenges in David's community.” As they discuss these challenges, it becomes clear to David that they are making assumptions about how Black people should receive care, about the perceived dangers of working with his community and about the frequent use of restraints and over-surveillance when providing care. David expresses his frustration about this with his team and the organization. Later, staff observe him venting loudly in the unit's common areas, and then returning to his bedroom.

The nursing staff encourage their leadership to transfer David to a more secure unit. They say he is a potential safety concern, and they do not feel comfortable, but do not explain further. Staff are reluctant to engage with him and say they “do not feel safe.”

Staff who know David say this is his common presentation. Nursing staff are still reluctant to support him (e.g., by going out with him for fresh air) or advocate on his behalf. They describe him as “threatening.”

He spends the next week mainly in his bedroom or pacing the unit and rapping loudly. This aligns with his previous presentations in the hospital and the community. The staff make few attempts to engage him throughout his stay.