“I Can’t Breathe” – Race, Restraint, and Policing Practices

On 21 August 2008, Sean Rigg died at Brixton Police Station after experiencing a mental health crisis. He was stopped by officers and kept in a dangerous prone position in the caged area at the back of a police van for approximately eight minutes. Despite being surrounded by multiple officers, Sean Rigg was not properly assessed at any point. When he collapsed, clad only in his underwear, officers claimed he was sleeping and faking unconsciousness. He died of “cardiac arrest following restraint in the prone position,” which was deemed “unnecessary” and “unsuitable.

Despite Sean Rigg’s racial identity being part of the terms of reference into his death, the initial IPCC report failed to engage with this issue. Race relations are frequently omitted from investigations despite increased awareness of the pervasive institutional racism within the police force, which has long evaded accountability.

More recently, Mouayed Bashir, a man of Sudanese descent, died following restraint by police in 2021. He was experiencing a mental health episode, lying on the floor in his underwear and kicking out in distress when an officer described his behaviour as “very aggressive.” The inquest into his death concluded that Mouayed “took an unknown quantity of cocaine, resulting in symptoms in keeping with ABD.” As INQUEST rightly stated, “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.”

It is well-known that people of colour, particularly men, are subjected to harmful stereotypes suggesting they are aggressive, volatile, violent, and dangerous. These stereotypes have deep roots in societal prejudices and are often exacerbated by the media portrayal of people of colour. When these stereotypes infiltrate the police force, the consequences can be fatal. This article examines police restraint practices and the severe risks they pose to people of colour in the UK.

‘Excited Delirium’ or Acute Behavioural Disturbance: A Justification for Excessive Force

The term ‘excited delirium’ originated when a medical examiner concluded that 32 Black women who worked as sex workers must have died from a combination of cocaine and sex, which he termed ‘excited delirium.’ The term has since taken on a life of its own, with police and medical examiners claiming that Black people were capable of exhibiting superhuman strength, insensitivity to pain, elevated heart rate, and aggression induced by drug abuse, thus justifying more severe methods of restraint.

‘Acute behavioural disturbance’ (ABD) and ‘excited delirium’ tend to be used interchangeably, though ABD is more common in the UK.

The College of Policing’s guidance on “Acute Behavioural Disturbance (ABD): Guidelines on Management in Police Custody” states, “Acute behavioural disturbance (ABD) is not a diagnosis as such. It is the ‘umbrella’ term for the clinical presentation of a number of conditions.”

Concerningly, the guidelines, dated October 2022, state: “In the past, the terms ABD and ‘excited delirium,’ or ‘excited delirium syndrome’ (ExDS), were sometimes used interchangeably, but only about a third of cases of ABD present as having ExDS when it is defined according to features which have proved controversial and without consideration of the presence or absence of delirium.”

It is alarming that this terminology is still used by the College of Policing when “the very existence of excited delirium is strongly disputed amongst medical professionals”. As stated in the 2011 Independent Advisory Panel (IAP) study: “The exact incidence of excited delirium (ED) is impossible to determine as there is no current standardised case definition to identify this state (deBard et al., 2009). It is currently not a recognised medical or psychiatric diagnosis according to either the Diagnostic and Statistical Manual of Mental Disorders (DSM-IVTR) of the American Psychiatric Association or the International Classification of Diseases (ICD-9) of the World Health Organization.”

In 2023,  the London NHS trust found that Black people were more than twice as likely to have ABD referenced in mental health assessments than white people. The IOPC recently stated, “We have decided to stop using the term ‘excited delirium’ as we recognize that it is language that is outdated and potentially offensive. We have removed it from IOPC forms that police forces use to make referrals to us and will not use the term as an option for categorising our investigations.”

Racial Stereotyping and Its Deadly Consequences

The use of terms like Acute Behavioural Disturbance and Excited Delirium by police forces can serve to justify excessive force, often disproportionately affecting people of colour. These terms, rooted in harmful stereotypes and lacking medical consensus, perpetuate a cycle of discrimination and violence that demands urgent redress.

Black people, and people of colour more broadly, are often perceived through a lens of suspicion and criminality. These perceptions are not just individual prejudices but are institutionalised within police forces. The dangerous stereotypes suggesting that Black individuals possess superhuman strength or are inherently more aggressive than their white counterparts contribute to a dehumanisation that can have fatal outcomes. These views are reflected in the disproportionate use of force against people of colour, especially during mental health crises, where care and de-escalation are urgently needed.

The systemic racism embedded in policing practices is further compounded by the misapplication of medical terms like ABD and Excited Delirium. These terms, often invoked in the aftermath of deaths in custody, shift the blame away from the officers’ actions and onto the victims themselves, suggesting that their deaths were due to their own physiological and psychological states rather than the excessive force used against them. This obfuscation prevents accountability and perpetuates a cycle of violence against people of colour.

The practice of using terms like Acute Behavioural Disturbance and Excited Delirium by police forces is a glaring example of how racial stereotyping and systemic racism continue to plague policing practices. These terms not only lack medical validity but also serve to justify the excessive and often lethal force used disproportionately against people of colour. It is imperative to challenge and dismantle these harmful practices and to hold police forces accountable for their actions to ensure justice and protection for all individuals, regardless of their race or mental health status.


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