The controversial, unconfirmed disease, which has its roots in pseudoscience and is questioned by doctors, is routinely used in the UK to explain deaths after police arrest, Observer found.
“Acute behavioral disorder” (ABD) and “excited delirium” are used to describe people who are agitated or behaving strangely, usually due to mental illness, drug use, or both. Symptoms are said to include insensitivity to pain, aggression, “superhuman” strength and an elevated heart rate.
Police and other emergency services say the labels, often used interchangeably, are a helpful shorthand used to determine when a person who may need medical attention and restraints may be dangerous. However, these terms are not recognized by the World Health Organization and have been condemned as “false” by campaigners who say they are used to “explain” the role of police in the deaths.
The American Medical Association has rejected the term “excited delirium” after it was used by police lawyers in the George Floyd case. In October, California lawmakers banned the drug's use as a diagnosis or cause of death, saying it “has been used for decades to explain mysterious deaths, mostly of Black and Brown people in police custody.”
The Royal College of Psychiatrists also warned that the current definition could lead to people “being subjected to avoidable and potentially harmful interventions”. In 2017, a Home Office review of deaths in police custody found that conditions were “strongly contested among healthcare workers”.
Despite constant controversy, Observer found that these terms are used by frontline police when deciding whether to use restraint, and by armed forces and their lawyers when explaining a death after the fact.
In one case, a man who was restrained by five police officers, most of them face down, for almost an hour after calling 999 that he was “behaving strangely” suffered from “acute behavioral disorder”.
An inquest in 2022 found that Krystian Kilkowski, 32, an engineer from Poland, had taken amphetamine, but not in a fatal dose, and concluded that “serious failings” in the use of restraint by Norfolk police contributed to his death in August 2020 The Independent Office for Police Conduct (IOPC) recommended further training but cleared officers of any wrongdoing, citing the ABD in its report. The disputed condition was listed as a contributing factor on his death certificate.
According to research conducted by the charity Inquest, the Royal College of Psychiatrists and Observer.
Deborah Coles, executive director of Inquest, said there was a danger that the use of these terms could distract from the “inherently dangerous” use of coercive measures by police against people in crisis.
She stated that references to ABD as a condition or diagnosis were inappropriate and that they were used “without question to downplay the importance of police use of force and to elucidate the role of unsafe and negligent coercion.” This could really undermine effective public control and accountability,” she said.
The use of the term in the context of mental health is also believed to be increasing, with a study by King's College London showing that references to ABD had become more common since 2019 and that black people were twice as likely to be included in assessments as in case of black people. who were white, which researchers say “may contribute to existing racial disparities in the use of restraints during crisis presentations.”
Suggestions that people with ABD may have greater strength and a higher tolerance for pain are based on racial stereotypes and are of particular concern, the Royal College of Psychiatrists has said.
Dr Trudi Seneviratne OBE, registrar at the college, said: “The way in which the term acute behavioral disorder is defined and understood varies significantly between professions. This is deeply problematic because of the way some signs and symptoms feed into racist stereotypes.
“The College is concerned that the term may be used to minimize the role of restraint in investigating causes of death. There is a risk that current definitions may undermine effective accountability, particularly in relation to deaths where no physical illness was present before the restraint was imposed.”
The issue of excited delirium gained attention again after Jon Ronson's podcast: Things fell apart, detailing how the term was still widely used in the US decades after its debunking. The term was coined in Miami in the 1980s after 32 black women who worked as prostitutes were found dead, naked from the waist down and with no visible injuries.
The cases baffled investigators until Charles Wetli, deputy chief medical examiner in Dade County, concluded that the women died from a “combination of cocaine and sex,” a phenomenon he called “excited delirium syndrome.” It was later discovered that the women had been murdered, most likely strangled during forced oral sex by 38-year-old Charles Henry Williams, who was legally linked to the cases.
Even after discovering the truth, Wetli continued to propagate his theory that delirium is excited by the real state. Since then, it has been used to explain sudden, mysterious deaths after contact with the police in the USA and other countries.
Police receive extensive training on ABD and learn how to recognize it. The College of Policing's current professional guidance refers to ABD as both a general term and a “condition”, even though it is not an official diagnosis, and says symptoms may include “insensitivity to pain and incapacitating sprays”.
The IOPC also uses both terms in its referral forms, which are used by police forces following a death or serious incident. When completing the form, the police are asked to select the appropriate factors in the report. The first option they get is “Acute Conduct Disorder/Excited Delirium.”
This weekend the IOPC and the College of Policing said they were reviewing the documents to consider whether updates were required. The College of Policing said its guidance focused on presentation, not diagnosis, and was clear that ABD was a “generic term”, adding that its position was based on guidance published by healthcare partners such as the Royal College of Emergency Medicine.
It said further research was needed to inform national policy, but one of the key messages in training materials on ABD was for officers to “avoid using physical restraint unless it is absolutely necessary for the safety of the victim, themselves or society.”
The IOPC said its investigation found a need for “clear, well-communicated guidance to police” that would help them identify cases where medical intervention was urgent and restraint created a “clear and obvious danger”. It said it welcomed new research into the use of terms “to better understand how emergency services can respond appropriately and provide appropriate care” but that any changes “must not reverse the progress that has been made”.
Dr Habib Naqvi MBE, director of the NHS Race and Health Observatory, said a multi-agency approach was needed to deliver “meaningful change” to improve approaches to people in mental health crisis and ensure that post-restraint deaths lead to lessons learned. to learn. “We can't just sit back and say, 'OK, we know this,' and do nothing about it,” he said.
Raju Bhatt, founding partner of the law firm Bhatt Murphy, which represents families of victims of police brutality, said addressing the issue is not just about reviewing old cases to ensure justice is served. “It is a much more urgent issue to stop more deaths. Now, today, tomorrow, next week,” he said.