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Diagnosis or Phenomenon…You Decide?

My first recollection of being knowingly introduced to this subject was around 2001 watching a video regarding the subject of Excited Delirium.

Back then the heading of cocaine induced psychosis and the disproportionate superhuman strength it gave to people was one of the non-clinical terms used.

This I felt had the unfortunate bias of implying if people displayed the behaviours taught to us during training, then they must be under the influence of drugs.

We eventually moved away from using cocaine induced psychosis as one of the key introductory terms during the teaching of this subject area.

The Independent Office for Police Conduct (IOPC) recently announced that it would cease using the term "excited delierium."

The decision by the IOPC reflects growing concerns about the term’s vagueness and its potential to obscure the underlying causes of distress in individuals experiencing severe agitation or psychosis.

ABD, along with the related term "excited delirium," has been criticised for lacking a clear, universally accepted medical definition.

This ambiguity has led to inconsistent application and potential misuse, with some critics arguing that these terms can be used to justify excessive use of force.

The move by the IOPC aims to ensure clearer communication and more precise categorisation of incidents involving individuals in mental health crises or severe distress.

The Faculty of Forensic & Legal Medicine (FFLM), part of the Royal College of Physicians, plays a crucial role in setting standards for the medical aspects of police work.

The FFLM has voiced concerns over the use of terms like ABD and excited delirium, highlighting that these terms are not well-defined medically and can obscure more accurate diagnoses.

The FFLM advocates for the use of clear, specific medical terminology to describe the symptoms and conditions of individuals.

The FFLM’s position emphasises the importance of using terms that accurately reflect the medical condition of individuals, promoting better understanding and more appropriate responses from enforcement agencies, people applying higher-risk restraints and medical personnel.

They recommend that police forces receive training to identify and manage conditions such as severe agitation, psychosis, and other mental health crises using terminology that aligns with medical standards.

Given the move away from terms like ABD and excited delirium, there is a need for alternative terminology that can be used in high-risk situations.

The FFLM and other medical authorities suggest focusing on the specific symptoms and behaviours exhibited by individuals rather than using broad, ambiguous terms.

Some recommended approaches include (note the emphasis on immediate medical evaluation/intervention):

  • Describing specific symptoms such as "severe agitation" or "violent psychosis."

  • Referring to recognised medical conditions like "acute psychotic episode" or "drug-induced psychosis."

  • Emphasising the need for immediate medical evaluation and intervention when individuals display extreme distress or erratic behaviour.

The National Police Chiefs’ Council (NPCC) recognises the importance of clear, precise language in police reports and communications.

Widespread support for terminology that is medically accurate and aids in the appropriate handling of individuals in crisis continues to grow.

The NPCC also emphasises the need for ongoing training and collaboration with medical professionals to ensure police responses are informed and humane.

Similarly, other regulatory bodies back the move towards more specific medical terminology.

They highlight that accurate language is crucial for safeguarding the health, safety and well-being of individuals in custody or care.

I believe that all regulatory bodies support efforts to improve the understanding of mental health issues and to ensure that individuals receive timely and appropriate medical care.

The decision by the IOPC to discontinue the use of the term acute behavioural disturbance (ABD) reflects a broader trend towards greater specificity and medical accuracy in describing the conditions of individuals in police custody.

Both the FFLM and other regulatory bodies advocate for the use of precise, symptom-based terminology.

This approach aims to enhance the understanding and management of mental health crises, ensuring that individuals in distress receive appropriate care and that actions are guided by clear and accurate information.

To effectively manage high-risk restraints, relevant personnel need comprehensive training that emphasises de-escalation, medical awareness, and the application of restraint techniques that prioritise the safety and well-being of all parties involved.

Here are 8 key components that should be included in such training:

1. De-Escalation Techniques

  • Communication skills

  • Crisis intervention

  • Empathy and rapport building

2. Medical and mental health awareness

  • Recognising medical conditions

  • Basic medical training

  • Mental health first aid

3. Restraint techniques

  • Awareness of high-risk restraints

  • Positional safety

  • Use of equipment

4. Legal and Ethical considerations

  • Human Rights

  • Policy and Procedures

  • Code of ethics

5. Scenario-Based Training

  • Realistic simulations

  • Role-Playing

  • Feedback and Reflection

6. Interagency Collaboration

  • Joint training with medical personnel

  • Coordination with mental health services

7. Continuous Education and Review

  • Regular refresher courses

  • Performance reviews

  • Updated best practices

8. Implementation/Revision of Training

  • Training programmes

  • Qualified instructors

  • Evaluation and feedback

By integrating these components into their training programmes organisations can better manage high-risk situations, reduce the potential for harm, and improve outcomes for individuals in crisis.

What about those delivering the training?

Trainers are more than just instructors; they are catalysts for learning.

Teaching is an art, and trainers must master it to effectively impart knowledge.

When trainers employ effective teaching techniques, they spark curiosity in learners, prompting them to seek further knowledge through reading, research, or additional training.

They will recognise that conflict management and resolution is an integral part of all physical intervention training

A qualified physical intervention trainer possesses expertise in the practical aspects of physical intervention.

They are proficient in techniques that ensure the safety of both parties involved.

Proper and accountable training minimises the risk of harm and liability.

From a legal perspective, the necessity of maintaining accreditation is paramount.

Annual refreshers and recertification ensure that trainers remain updated with the latest techniques, safety protocols, and legal regulations.

Failure to do so can lead to legal liabilities, compromising the safety of both trainers and trainees.

Trainers who stay current not only fulfil their legal obligations but also uphold ethical standards, demonstrating their commitment to providing the highest quality training possible.

In many countries, laws require that physical intervention trainers maintain their qualifications and certifications to continue offering their services.

Experts in delivering training understand the power of motivation and inspiration.

These trainers create a dynamic learning environment where learners feel encouraged to explore beyond the immediate training sessions.

They share real-life experiences, case studies, and resources, fostering a culture of continuous learning among their trainees.

Trainers who excel in their role not only comply with the law but also inspire a passion for learning in their students.

They nurture a culture of lifelong learning that extends far beyond the training room, making them invaluable assets where physical intervention and conflict management training is essential.

Upholding competence through CPD is not just a legal obligation; it is a commitment to the safety and well-being of all involved.

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