An inquest in Newport, Gwent has concluded after hearing three weeks of evidence, following the death of Mouayed Bashir in 2021. The jury returned a short, narrative verdict concluding a finding his death was caused by cocaine intoxication, contributed to by Acute Behavioural Disturbance (ABD) following a period of restraint.
His Majesty’s Coroner stated that police restraint did not affect the outcome as the medical evidence suggested Mr Bashir’s death could have been caused by cocaine alone.
BACKGROUND
Mr Bashir’s family phoned their GP one morning in February 2021 for help during a mental health emergency. They stated he had consumed cocaine and they were advised to ring 999. Criticism was implied and indeed offered during the course of the inquest that the police were sent, not an ambulance but upon the arrival of the first police officers, Mr Bashir was found barricaded in his room so I doubt the ambulance service would have been able to lead the initial response and the first police officers on scene did emphasise shortly after arrival an ambulance would required.
Due to their concerns, officers forced entry to the room and found Mr Bashir lying on the ground kicking out, wearing only his underwear. Feeling he was experiencing a mental health episode, they restraint him, including handcuffs to the rear and leg restraints, potentially influenced by warning markers on his record for drugs and weapons. He was described in evidence by the officers as “very aggressive” albeit his family’s perception was that he was distressed and in need of help. It’s worth noting those two things are not incompatible – people who need help can sometimes be aggressive; and aggression can be a result of various illness. Restraint was ongoing for over half an hour at the point where Mr Bashir became unresponsive. Expert evidence at the inquest considered the relevance of Acute Behavioural Disturbance (ABD), which is a descriptive term for a presentation which amounts to a medical emergency – it is not a medical diagnosis.
Police and paramedics at the inquest reported that they had been trained in ABD, but did not at the time immediately recognise the incident as potentially involving this – two officers were on body-worn video discussing ABD and most of them recorded ABD on the use of force forms. They chased up the ambulance service a number of times and paramedics arrived just after 10am, about an hour after the police arrived. After half ten, after being moved to the ambulance, he went in to cardiac arrest and was taken to hospital but could not be resuscitated.
INQUEST CONCLUSION
The coroner specifically directed the jury not to comment on issues which did not directly cause Mouayed’s death in their narrative conclusions, including the issue of whether or not he should have been restrained. I was interested from the time of this incident in the legal basis for the officers’ intervention and saw nothing reported about this at all. We know Mr Bashir was not arrested for any offence and we know he could not be detained by the police under section 136 of the Mental Health Act – as such, the legal basis for intervention could only really have been the Mental Capacity Act 2005 or common law – I would have liked to know more about what was said at the inquest about this. I suspect, intervention in a situation like this would justify reliance on the MCA, but I’d need to know more.
The jury observed a number of things, in addition to their belief that an “unknown quantity of cocaine” resulted in Mr Bashir “developing symptoms in keeping with ABD”. They concluded restraint was done for his safety and that of others, bearing in mind BWV showed him kicking out at officers when they entered the room. But they did observe “insufficient knowledge around identifying some of the signs of ABD” and that throughout restraint, his condition was deteriorating.
Mr Bashir’s family were supported by the charity Inquest and lawyers from the Inquest group of lawyers, including Fiona Murphy KC. I thought Inquest’s press release said something worth untangling, because I’ve seen them say similar things before in mental health crisis situations where restraint has been used and I’ve often agreed with their instinct. But in this particular case, I wondered about it –
“Mouayed’s family called for help for a mental health crisis. Police were sent. Before even entering the property, officers were thinking more about criminality than care. Despite being aware of his mental ill health, police responded by restraining Mouayed without even attempting de-escalation or support. They saw his behaviour as ‘aggressive’ not distressed. This follows a national pattern of disproportionate use of force against Black men in mental health crisis by the police. Despite longstanding awareness of this issue, it is clear that the police’s culture and current approach is still not fit for purpose. Care and de-escalation must be prioritised in place of dangerous restraint by all professionals charged with responding to situations like this. This is yet another reminder of why police cannot and should not be first responders to people in mental health crisis.”
Lucy McKay, Inquest. [Bold is my emphasis.]
LANGUAGE IS KEY
Firstly, let’s deal with de-escalation – we hear this a lot, as if to suggest the police never de-escalate situations and I’ve written about this before.
Mr Bashir was on the other side of a door which was thought to be barricaded and there was intelligence about previous possession of weapons, possibly possess or use of drugs. We now know the jury think his cocaine use had contributed to ABD or similar. Notwithstanding debate which has run for decades in the United Kingdom about whether ABD is diagnosis (it’s not) or a disorder (it’s not), when you have discussions about this with doctors, which I’ve done a lot over that decade, you almost always find the doctor will say that regardless of the taxonomy or the debate, the group of “things” which are often considered to amount to ABD when taken together, creates a medical emergency.
So if you think you are dealing with an ABD situation involving someone on the other side of a barricaded door and you decide to contain and negotiate, how long do you use that approach if you also have to worry you are delaying an intervention which may be key to saving someone’s life, bearing in mind some medical sources report a 10% fatality rate from ABD without intervention and the medical evidence in this case suggests Mr Bashir’s tragic case may have been one of those.
Secondly, they saw him as “aggressive, not distressed” – the officers are on record as stating they thought he was having a mental health episode and they called an ambulance before undertaking any substantive intervention. We should be able to accept that suggests at least some kind of recognition they weren’t “thinking more about criminality than care”. if they were, they could have easily justified arresting Mr Bashir for attempted assault when they entered the room – but they didn’t. Even within the context of care, we can still recognise and acknowledge aggression, bearing in mind the officers were the ones who would have to get close to Mr Bashir when he was kicking out at them. Distress and aggression are not mutually exclusive concepts – actually, very far from it.
FIRST RESPONDERS
But it’s the final two sentences from Inquest (in bold, above) which left me shaking my head, somewhat. I’m genuinely struggling to see how the police service could be anything other than first responders to this situation, which was always acknowledged to be a mental health crisis. Put it another way: try ringing 999 and ask for paramedics to deal with a mental health crisis incident where the patient is barricaded in a room, has a history of weapons possession and is agitated, acting bizarrely. Remember that once someone went through the door, the patient in distress was kicking out. This is not something paramedics sign up to deal with and violence towards NHS staff – however caused – is a major issue and the ambulance service is in the heart of that, facing more than their fair share.
Treatment for ABD and effective intervention can only realistically happen when the patient is sufficiently accessible to allow paramedics or doctors to use medication, often used without consent and it is even better done in an Emergency Department than an ambulance. It’s worth remembering the police are, in the end, the only group of people who can be asked to undertake the dangerous and uncertain tasks which help create those conditions or move the unwilling over distance and whilst there is plenty of restraint incidents where we can criticise the police, this doesn’t mean that all restraint incidents are worthy of criticism.
A Preventing Future Deaths report has been issued by the Coroner about the importance of communication amongst police officers about ABD.
There is more ABD content on my specific ABD resources page.
Winner of the President’s Medal, the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation. (c) Michael Brown, 2024
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 