March 23, 2024

California banned the term “excited delirium.” Will it make a difference?


PERF members,

In October, California Governor Gavin Newsom signed Assembly Bill 360 regarding use of the term “excited delirium.” Under the law:

  • Excited delirium is prohibited “from being recognized as a valid medical diagnosis or cause of death in [the] state;”
  • Peace officers are prohibited “from using the term ‘excited delirium’ to describe an individual in an incident report;” and
  • “Evidence that a person experienced or suffered excited delirium” is deemed inadmissible in a civil action.

Peace officers and those testifying in civil cases are permitted to describe individuals’ behaviors and relevant characteristics, but they may not attribute them to excited delirium.

This isn’t only controversial in California. According to the Kaiser Family Foundation, bills about the use of the term “excited delirium” are also under consideration in Colorado, Hawaii, Minnesota, and New York.

The medical community has also weighed in. In a 2020 position statement, the American Psychiatric Association said “’excited delirium’ is too non-specific to meaningfully describe and convey information about a person.” In 2021, the American Medical Association adopted a policy opposing the use of “excited delirium” as a medical diagnosis. Last year, the National Association of Medical Examiners, which had previously recognized excited delirium as a factor in certain in-custody deaths, announced that the term is not endorsed by the organization, and instead urged “that the underlying cause . . . for the delirious state be determined (if possible) and used for death certification.”

And the American College of Emergency Physicians, which published a 2009 report finding that “’excited delirium’ is a unique syndrome, identified by the presence of a distinctive group of clinical and behavioral characteristics,” said in 2021 that the 2009 report was “outdated and [did] not align with the College’s position.” The organization now recognizes “hyperactive delirium syndrome with severe agitation, a potentially life-threatening clinical condition characterized by a combination of vital sign abnormalities (e.g., elevated temperature and blood pressure), pronounced agitation, altered mental status, and metabolic derangements.”

The term "excited delirium" has become a lightning rod that evokes strong reactions on all sides. Advocates and many in the medical profession have raised legitimate concerns that the term was being applied too broadly and used to justify too many fatal incidents involving police restraint. At the same time, police have raised legitimate concerns about having primary responsibility for handling people who are in crisis, difficult to engage, and need medical attention. I worry that we’re looking for a quick-fix by banning a term without addressing the underlying issue – how law enforcement officers should be trained to respond when they encounter people exhibiting certain characteristics largely associated with that term.

When I talk to police chiefs in California and elsewhere, there is real angst – not because using a term is forbidden, but because debate about the term avoids the harder question of how officers should be trained to deal with people going through this type of often drug-induced medical emergency and/or mental health crisis. We should be using the brouhaha created by the California legislature’s actions to shine a spotlight on an issue that will not go away, no matter what we call it. 

When someone is in public, in crisis, and largely not in control of their actions, who owns the problem? It’s clearly a medical issue – after all, the person is a danger to themselves, and possibly others. But who will be called on to immediately address this medical issue? The police. Shouldn’t we be providing officers with better guidance on how best to respond in these circumstances? How can we develop protocols for police based on sound medical advice that can best protect the person in crisis and others from harm?

Police will continue to encounter these people, whether we call their crises “excited delirium,” “hyperactive delirium,” or simply describe their behavior. If we want to improve the response and the outcomes, we need to reevaluate policies, training, and coordination between the various responders, including police, dispatchers, EMS, and medical staff at hospitals.

I spoke with Palm Springs, California Police Chief Andy Mills about this issue, and he told me that cops struggle to protect everyone’s safety during these difficult situations and fear that they will be prosecuted if the person they are trying to physically get under control dies. Andy also pointed out that this legislation didn’t include any training resources to help police, EMS, and others to improve the response to these situations. He closed by telling me, “The last thing we should worry about is what we call it; we should fix it.”

I see similarities between this issue and suicide by cop, a controversial topic that PERF also addressed head-on. Some felt the term “suicide by cop” was used to justify what many believed to be avoidable deaths, so PERF worked with professionals to develop protocols and training to help police and dispatchers identify people who might be suicidal and equip police with the tools they needed to resolve the incidents as safely as possible. 

Our guiding principle has been, and will continue to be, protecting human life; this means giving the working cop who, at 3:00 a.m., needs to deal with a high-stress situation, the best knowledge and skills to resolve that situation safely for everyone. In that regard, PERF plans to bring medical officials, dispatchers, EMTs, and police experts together to develop some much-needed guidance on how to best handle these challenging circumstances. We look forward to your input when we discuss this at the PERF Annual Meeting in Orlando on May 29-31. I hope to see you all there and hear your thoughts!