In Virginia well over half of the jurisdictions have policies requiring people who are in law enforcements custody at an emergency department under an Emergency Custody Order (ECO) or a Temporary Detention Order (TDO) MUST be handcuffed to a bed. Most of the law enforcement agencies in my area require one point of restraint some require two points of restraint. The hospital I work at prefers two points of restraint in their policy. ECO's last up to eight hours. If the person under an ECO receives a TDO they are still in custody until they are able to transport them to a mental health facility. TDO's are 72 hours for adults and 96 hours for adolescents and are active until a commitment hearing is conducted. Commitment hearings are not conducted on weekends or holidays.

The restraints are mandatory regardless of the disposition of the person in custody. Because of a shortage of open beds in mental health facilities or if the person has other conditions that make them a difficult placement at private facilities people are often handcuffed to beds for days at a time. 

Populations that are most at risk of having to wait for days to be placed are adolescents, geriatric, and people with additional medical needs. People who are non verbal and have autism almost always serve their entire TDO handcuffed to a bed.

At one time the deputies and law enforcement officers I work with used to have a degree of discretion as far as the need for restraints. They no longer do. At mental health facilities restraints can only be used when an individual is in immediate danger of hurting themselves or others and the restraints must come off when that danger has passed.  This is not true in emergency departments across the state.