Youâ€™ve may heard the term â€˜Excited deliriumâ€™?Â I wrote a blog on it a few years ago. You may also have heard the termÂ â€˜acute behavioural disturbanceâ€™ or â€˜acute behavioural disorderâ€™? â€¦ these things may, in fact, be the same thing. Or they may not be the same thing. Actually, it may be three separate things or they may not even be a thing. Or things.
I hope Iâ€™ve cleared up the science behind these terms for you?
You may well have noticed: Iâ€™m neither a doctor nor a scientist â€“ I ditched my science education at 16yrs old so itâ€™s fair to say that Iâ€™m not the best person to ask about this stuff.Â You should probably ring a doctor â€¦ or doctors. Actually, if youâ€™re going to ring a doctor, you should ring more than one because there is a distinct possibility that youâ€™ll select one that will give you an answer that most of the others donâ€™t agree with. You see, the medical profession are still debating this stuff and Iâ€™ve covered this point before â€“ several times. There are doctors of various kinds who will tell you if you stand still long enough that these are not valid medical or scientific terms â€“ some will go further and insist that they are actually quite meaningless, not mentioned in the medical classifications of disease, etc.. There are others who will stop short of that, by accepting that more needs to be known and that to the extent there is any validity in any of these terms, they probably need to be used very carefully to describe certain, specific medical issues when presented in particular circumstances where the effect of (not always illegal) drugs are often involved.Â And all of this before we even begin to discuss the issue of restraint and policing.
Professor Hugh MONTGOMERY and Dr Fionna MOORE, the medical director of the London Ambulance Service feature in the training film Safety In Mind, jointly produced by South London and Maudsley NHS Trust, the LAS and the Metropolitan Police. I invite anyone who thinks this stuff is not a real thing, to contact them and have it out in the seminar room (or the car park if you have to) â€“ let me know the outcome of the discussion.
Meanwhile inÂ the real world, 999 calls keep coming in to the police. Difficult situations and challenging members of society are being increasingly deflected in to the emergency system (not just the police!) by other mechanisms of social justice that are contracting before our eyes and re-defining their priorities and their paradigms, to justify radical service re-design.Â At least twice in 2015, Her Majestyâ€™s Coroners have returned narrative verdicts of deaths connected to these various concepts and accompanied by other mechanisms. We keep seeing Regulation 28 notices from Coroners expressing reservation about these things and seeking improvement.
Meanwhile in medicine, the Royal College of Emergency Medicine are apparently holding weekend seminars and drafting new guidelines for ABD. The National Institute of Clinical Excellence (NICE) have updated their 2005 guidelines on the short-term management of disturbed behaviour and phrases along these lines are included. In fairness, they were included in 2005, too.
So you can form you own view and think what you want about the aetiology of so-called ABD or Excited Delirium: Iâ€™m utterly unqualified to take a position on it or to tell you what to think. What I can say, because Iâ€™m a professional legal officer, is that courts rule that people die from this. I can also point out that Doctors with more or less equal right to be taken seriously are contradicting each other as badly as lay people are likely to do if they were brought in to debate the whole thing. I can also point out that published documents from medical authorities like Royal Colleges, NICE or academic journals mention these things.
Iâ€™m genuinely way beyond caring, strictly speaking, whether this is syndrome, a disorder or a condition â€“ Iâ€™m not even bothered whether it is a thing. What I am bothered about is people dying in police custody after the same weary old story of a police intervention with someone who was often well-known to mental health services, who may have taken drugs â€“ and I donâ€™t distinguish between illegal drugs or prescribed medication because we all know that the latter can go badly awry â€“ and then a restraint related intervention happens which various reputable sources tell us should be treated as a medical emergency, except for that inconvenient fact that the NHS is often unable to support the officersâ€™ decision-making.
If youâ€™re spending your time wondering about whether Acute Behavioural Disorder is a thing â€“ Iâ€™m told this is the latest term for whatever it is people are trying to define and describe â€“ then youâ€™re wondering about the wrong thing, legally speaking. And as Iâ€™m a policeman, not a doctor, I tend to think and speak legally rather than clinically. (Must remember to refresh my first aid certificate.) And legally, things are very, very clear: Coroners in Her Majestyâ€™s Courts are telling us people have died and that we need to do more and we need to do better.
This BLOG is a short one because the points have been made previously and elsewhere by others. Itâ€™s one of those zombie discussions that doesnâ€™t go away, because people keep making the same points as if the unresolved medical debates mean we can keep disregarding the adverse Coronerâ€™s findings. If the legal system is guilty of having to make real decisions in the real world amidst uncertainty and ambiguity, then I can live with that. What I canâ€™t easily reconcile is the shouting from the sidelines that this thing is not a thing, without any real effort to support the frontline police officers and paramedics who are having to deal with the reality of a world in which we all knew before we started that we donâ€™t know everything.Â As President Theodore ROOSEVELT once remarked, â€œItâ€™s not the critic who counts â€¦ itâ€™s the man [sic] who is actually in the arena.â€