ABD Resources

The various various documents, guidelines and position statements which have any bearing on the subject of Acute Behavioural Disturbance are below.  I will add to this in due course, with PFDs from inquests which raised the topic and any other material I come across.

The Resus Room (see below) describes Acute Behavioural Disturbance as –

“One of the most challenging, dangerous and serious presentations that we will encounter in emergency management of patients.  There is no widely accepted definition of ABD. Really it’s an umbrella term for a patient presenting with a triad of features, secondary to a specific underlying cause, made up of Delirium; severe agitation and aggressive behaviour; and autonomic dysfunction”

GUIDELINES AND POSITION STATEMENTS

INQUEST PFD REPORTS

NB: these inquests did not necessarily reach a finding of ABD as a causal or contributory factor leading to someone’s death, but where they did not, they did include discussion and debate about officers’ ability to recognise or manage ABD.

  • Olaseni Lewis, died-2010; conclusion-2017 – speaks to issues around ABD and restraint; as well as the medical oversight of police responses in medical settings during police attendance at a disturbance in a mental health setting.
  • Kingsley Burrell, d-2011, c-2015– speaks to issues on ABD / restraint; as well as the street triage as a generic solution when it’s unlikely to have affected this type of incident.  Of note on triage, is the response from the Metropolitan Police Commander who was NPCC lead at the time.
  • Terry Smith, d-2013, c-2018 – speaks to issues around ABD and restraint; as well as the ambulance service interface with the police during MH crisis.
  • Leon Briggs, d-2013, c-2021 – speaks to the need for clear, effective protocols (s136) as well as training for police officers and greater awareness of post-restraint monitoring of those subject to a use of force.
  • Darren Cumberbatch, d-2017, c-2019 – speak to issues around ABD, restraint and the use of force, as well as the Probation Service’s awareness of ABD.
  • Douglas Oak, d-2017, c-2019 – speaks to issues around ABD and restraint; as well as the ambulance service interface with the police during MH crisis.
  • Kevin Clarke, d-2018, c-2020 – speaks to issues around ABD and restraint; as well as the ambulance service interface with the police during MH crisis, including inadequate clinical assessment and inherent medical risks.
  • Adam Stone, d-2019, c-2022 — speaks about an ABD intervention by the police, appropriateness of police actions, inc restraint and is addressed to the ambulance service to ensure category 1 responses for ABD
  • Mouayed Bashir, d-2021, c-2024 – speaks to the importance of all officers, esp junior officers, speaking up about concerns someone may have ABD.
  • Kevin Cashin, d-2022, c-2024 — highlights the importance of ABD / first-aid training covering “agonal breathing” and recognition of cardiac arrest after a delay in reaction to a man detained and restrained after cocaine-induced ABD.
  • Roberto Bettello, d-2020, c-2024 — speaks to the important of communication between and amongst agencies, situational security and the duty of candour after an untoward incident.

MY POSTS ON ABD

Because of the endless debate on ABD and the inquests where it features, as above, I have ended up writing a number of posts.  Some of them summarise the issues involved from my perspective, others are announcing the reports and documents you see above.

You can search for ABD related posts by opening the menu in the top right corner and use the search function to search “ABD” – plenty of results will come back.  That said, the mains ones, including guest posts by a consultant in emergency medicine include —

  • Excited Delirium — my first post on the topic, when the ED terminology was preferred or prevalent.  People still argue now about whether ED and ABD are the same thing or whether ED is just one type of ABD.
  • Position Statement – RCPsych — the Royal College of Psychiatrists published a revised and expanded position statement in 2022, having published a brief position statement in 2021 which caused some consternation, esp with the Police Federation who published a fairly embarrassing response to it!  This is their updated document, which is extremely useful in terms of history and research.
  • ABD and the Ambulance Service — speaks for itself, including publication of the College of Paramedics position statement on ABD.
  • New ABD Guidelines — a post about the 2016 publication of new guidelines from the Royal College of Emergency Medicine.  Please note, those guidelines have since been updated and the latest edition is linked, above.
  • ABD – a medical  perspective — a three part guest post by a consultant in emergency medicine.  You can then read part two and part three.

And you may or may not wonder what my perspective is? … well, I wrote this in 2015 and it still sums up where we are with this, as far as I’m able to tell —

“You may heard the term ‘Excited delirium’?  I wrote a blog on it a few years ago. You may also have heard the term ‘acute behavioural disturbance’ or ‘acute behavioural disorder’? … 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 I’ve cleared up the science behind these terms for you?”

OTHER MEDIA

Winner of the President’s Medal, the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award

 

All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2025
I am not a police officer.

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