The Vice Chair of the Police Federation of England & Wales (PFEW) has refuted and condemned a hugely damaging article on the website of The Royal College of Psychiatrists which expressed concern over the increasing use of 'Acute Behavioural Disturbance (ABD)' as a diagnosis or syndrome for people who are behaviourally disturbed.

In a move which could impact negatively on every police incident involving individuals with the condition, The Royal College of Psychiatrists said it: “Does not support the use of such terminology, which has no empirical evidential basis.”

The highly flawed report called into question the impartiality of Coroners and linked the inquest of Kevin Clarke and the case of Leon Briggs to the College’s unexpected stance, describing the concept of ABD as ‘fundamentally flawed.’

PFEW Vice Chair Ché Donald criticised the College’s decision to publish the article without prior consultation or engagement with policing or the Royal College of Emergency Medicine, and said the move jeopardised existing College of Policing guidelines for officers dealing with cases involving ABD.

Mr Donald said: “The Royal College of Psychiatry, which is a charity, should focus its energy and attention on areas it has expertise in, rather than issuing factually incorrect, politicised statements.

“Our members are owed an apology for this, and we will be referring this to the Charity Commission for England and Wales.

“Our members could now face inquests without the protection of long-established guidelines which permit police officers to legally treat incidents involving ABD as medical emergencies.

“We also ask the question as to why the Royal College of Psychiatry has not directed the purported concerns to individual coroners or the Chief Coroner?

“By casting doubt on the existence of ABD as a recognised condition, police officers would have to treat any situation involving a behaviourally disturbed person in the same way as any other.

“This would mean we would have to treat individuals in the midst of a medical emergency in the same way as any other criminal. There would be no clear guidelines over the use of force on highly agitated individuals who were unwell, and this could put members in an invidious position where they faced unfair criticism for just doing their jobs.”

 

In a rebuttal made directly to The Royal College of Psychiatrists web article, PFEW pointed out that:

• The term Excited Delirium (ED)was changed to Acute Behavioural Disturbance (ABD) by Police Forces and Royal College of Emergency Medicine to support the fact ABD is not a diagnosis, but a description of a group of signs and symptoms with a multitude of possible causes. The Royal College of Psychiatry statement is incorrect as ED or ABD have been used for many years in Inquests and in the US.
• The statement is inaccurate as the term ABD has not been used by Coroners to “to limit the responsibility of authorities involved in the deaths of those in custody or medical services” as stated.   
• Coroners are Independent and an Inquest is an inquiry to ascertain the facts relating to the death of a person, namely who has died and how, when and where they died. The Coroner decides which issues need to be looked at, and what evidence should be heard. All Coroners have provided opportunities for any concerns with any authorities (health, police, fire etc) to be explored. This is especially so as any deaths in custody is subject to Article 2. To suggest that Coroners are not independent and are not able to discern such facts is extremely concerning.  
• The current version of the College of Policing guidelines emphasises the early recognition of ABD - as well de-escalation as the first approach (and that restraint should be minimised). Officers are not required to diagnose the cause of ABD but to treat ABD as a medical emergency so that the Emergency department is the right place for the person and not as a s136 or psychiatric referral. It is about the recognition of ABD, and treating individuals presenting with these symptoms as patients not prisoners.
• ABD is a term used for police, ambulance trust and Emergency physicians, and psychiatrists are not involved in these cases until all medical causes are ruled out and the person is in a safe and stable condition. Therefore, the management of ABD is out of scope for a psychiatrist.
• It is also incorrect for the Royal College of Psychiatry to state: “that ABD has been used in a number of high-profile cases, to explain why a person has died under restraint. This was seen during the inquest of Kevin Clarke and also recently referred to in the case of Leon Briggs.” ABD was not used to explain why they had died, but to describe the condition. In both cases the accountability of the police and health service were also explored - contradicting the RCPYS statement.
• The Royal College of Psychiatry is incorrect in stating: 'superhuman strength’ is an alleged symptom. Strength is well recognised in Inquests, from CCTV and other evidence as a possible sign. The latest version of the College of Policing ABD training recognised the lack of agitation may also be a sign of late stage ABD - i.e. exhaustion. There is no evidence to support the Royal College of Psychiatry statement that recognition of: 'superhuman strength' adds to the risk that the response from agencies will be excessive. 
• We also dispute the claim made that: "evidence this is disproportionately the case with black people and that therefore the use of these terms is, in effect, racial discrimination.”