Bay Area Rapid Transit (BART) Police Officers will no longer use the controversial term “excited delirium.” BART says the term has been removed from the BART Police Department (BPD) policy manual and a departmental bulletin informing officers of the change has been issued.
“This policy change affirms BPD’s commitment to continuous improvement through policy changes and ongoing training that exceeds industry standards,” said BART Police Chief Ed Alvarez.
The removal of the term was recommended by the BART Office of the Independent Police Auditor with the revision of the policy manual endorsed by the BART Police Citizen Review Board.
“Removing this terminology from the BPD policy manual is a meaningful step toward racial equity in policing at BART. I and my team look forward to monitoring the implementation of this policy revision,” said BART's Independent Police Auditor Russell Bloom.
What’s in a term?
The term “excited delirium,” also known as excited delirium syndrome or ExDs, emerged in the 1980s to describe an onset of agitation, confusion or aggression. The term is also cited within law enforcement to detain or use deadly force because a person in a state of “excited delirium” exhibits behavior that is believed to be a threat.1 An article published in the Virginia Law Review on Dec. 28, 2021, by Osagie K. Obasogie, looked at data and found there were 166 reported instances of individuals who died in police custody between 2010 and 2020 where excited delirium was cited as a possible cause of death. Of those 166 individuals, 43.3 percent were Black people and when Latinx people were added, the percentage increases to 56 percent.
While the statistics are shocking, the use of “excited delirium” as a medical diagnosis is not as clear as it probably should be.
The American College of Emergency Physicians (ACEP) and the National Association of Medical Examiners recognize the diagnosis. A recent ACEP task force report on hyperactive delirium states “while it is often impossible to accurately differentiate causes of hyperactive delirium with severe agitation early in the patient encounter, best practice is to initially attempt de-escalation techniques.” The ACEP task force report noted restraints are “not a substitute for adequate treatment of severe agitation” and recognized that pharmacologic management, such as the use of ketamine, “is often necessary.”
The term is not recognized by the American Psychiatric Association (APA) nor the American Medical Association (AMA). Both have adopted policy opposing the use of excited delirium as a diagnosis. The APA’s policy labels the term “too non-specific to meaningfully describe and convey information about a person” and both the APA and AMA policies recommend not using the term until a clear set of diagnostic criteria is established and validated.
BART also points to the work performed by the Physicians for Human Rights (PHR), which reconstructed the history of the term through a review of medical literature, news archives and deposition transcripts of expert witnesses in wrongful death cases. PHR’s 2022 report concludes that the term “excited delirium” cannot be disentangled from its racist and unscientific origins and therefore should not be cited as a cause of death.
PHR researchers concluded the term is scientifically meaningless due to a “lack of consensus or rigorous evidentiary basis.” PHR found that “excited delirium” does not have a clear or consistent definition, established etiology or known underlying pathophysiology.”
Joanna Naples-Mitchell, PHR U.S. research advisor and co-author of the 2022 report, applauded the move by BART to remove the term from its policing manual and urged other law enforcement agencies to do the same.
“Ending the use of this pseudoscientific term is an important first step and we urge BART to ensure full implementation of this change in policy and practice. ‘Excited delirium’ was dangerous and destructive from its inception in the 1980s. It has no place in modern medicine or law enforcement,” said Naples-Mitchell. “BART’s approach should become a model for other police departments to change their policies.”
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