Hi Smokey. Put your fears to rest because they are completely unfounded. I'm in a position to know, as I've worked in psych facilities and in jails. I've observed people being transported by police. If you are under arrest for unlawful behavior, there's a good chance that police will cuff you. Outside of that, it would be unusual for restraints to be used.

First if all, the law says that healthcare personnel must use only the absolute minimum amount if restraint needed to keep you from harming yourself, or others. No one will assume that you are dangerous just because you are having a psychological crisis. Suicidal thinking, by itself, in the absence of a well thought out plan and expressions of strong intent to follow through, is not automatically thought to make you dangerous.

Even when it is feared that you may harm yourself, the first thing that is tried is to keep you under direct observation. Even inside jails, this is the main response - to have the person sleep where they are under direct observation by staff. (Not inside a jail cell, for instance, but out in the open.)

Personnel in an ambulance, or in an emergency room, do have restraints that can be applied to wrists and ankles, but they are usually used for people who are very confused and highly agitated - to the point that they are trying to pull out I/V lines and pull off oxygen masks. First, staff will see if offerring you verbal assurance is able to calm you down.

A friend of mine worked in a facility where he sometimes transported psych patients from the local hospital to the main state psychiatric hospital. Typically, they would travel in a regular automobile. One staff member would drive, and a second staff member would sit in the back seat with the patient. No restraints would be used (other than regular car seat belts.) If the person being transported would become assaultive toward these staff persons, they had the option of stopping and calling police to take over.

Cops don't particularly like to transport persons they deem to have a medical problem. They prefer to have paramedics do that. Paramedics will use restraints only as a last resort.

There are medical risks that come with restraints. First of all, being in restraints can cause a person's heart rate and blood pressure to go up. Healthcare personnel want to avoid that. Also, a restrained person who begins vomitting is at higher risk for inhaling the vomit, which is awfully dangerous.

Restraints are being used less than they used to be. In hospitals, patients who would have been restrained in the past, now, are more likely to have a staff person assigned to sit with them and hold their hands and speak reassuringly to them.

The guidelines for use of restraints do not vary from county to county as you are imagining. Guidelines are provided by sources that have national standing. "Standards of care" (including those pertaining to the appropriate use of restraints) tend to be pretty uniform throughout the country.

If a psychiatrist in an office thinks you should go to an ER or psych facility, first the pdoc will see if you can reasonably be encouraged to take yourself there, or call a family member to take you.

Men in white coats putting you in a straight jacket and/or tying you to a gurney is mostly something we now mainly see in old movies. I know of a situation where a patient was put in a straight jacket and taken from the hospital ER to the state psych hospital. That was after this person belligerantly punched an ER doctor in the face. That's the kind of provocation that gets a person tied up . . . and rightfully so.

Saying you are having suicidal thoughts absolutely does not automatically get you tied up.