Excited Delirium Syndrome And Driving Whilst Uninsured
This item has been published in the newsletter Expert Healthcare Witness Matters and written by Professor Keith Rix, an Honorary Fellow of the FFLM, its first Expert Witness Lead, and a previous Mental Health and Intellectual Disability Lead of the FFLM. He is a Door Tenant, The Chambers of Mark Love, 2 Dr Johnson’s Buildings, Inner Temple.
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Readers will know that I rely heavily on The Spectator for information about attention deficit hyperactivity disorder and autism spectrum disorder. I had not expected it to be a source of information about so-called ‘excited delirium syndrome’, but in the 11 April 2026 issue, Rod Liddle asks – and it’s the title of his piece – ‘Do you suffer from ‘excited delirium syndrome?’ Liddle tells readers:
Hadiza Atunse, a 25-year-old PA, smashed her Toyota Auris into a Mini Cooper, spun out of control and flipped into a hedgerow in Wilmslow, near Manchester. When the coppers turned up, she declined to partake in a breathalyser, and the police, mysteriously, did not give her a tongue swab to determine drug use. I say ‘mysteriously’ because the young lady was also found with a large bag of Coke in her car.
Later, it was discovered that she was driving without insurance. Yet Ms Atunse copped only a £730 fine because the judge seems to have accepted the defence’s argument that she had been suffering from ‘excited delirium syndrome’, which, coincidentally, is what afflicts me in the moments before Bargain Hunt comes on the TV. I run backwards and forwards between the kitchen and the lounge, preparing my Bargain Hunt snack of a mug of tea and two Petit-Beurre biscuits and, wrapped in a pre-show exhilaration, wonder to myself, will one of the experts be the lovely Izzie Balmer, or will it be Danny Sebastian with his grating histrionics? Will the contestants win a Golden Gavel?
This seems to me to be such an unusual case, and as, potentially, it adds to our understanding of this controversial syndrome, I expect that the expert involved is already writing it up for the Journal of Forensic and Legal Medicine or Medicine, Science and the Law, and I would not want to steal his or her thunder, but I am minded to comment.
At first glance, I thought that excited delirium syndrome had been put forward as a mental condition defence. But then I thought that the defence would have been unlikely to find an expert who would testify that excited delirium syndrome can last for weeks, months or years, or however long it was since Ms Atunse’s insurance expired or when it was that she decided not to obtain any. In any event, she was convicted and a more detailed account of this case, published in The Daily Mail, along with a photograph of Ms Atunse and her handbag, revealed that she was suffering ‘a bout of ‘excited delirium syndrome’ at the time of the smash’ (https://www.dailymail.co.uk/news/article-15712105/Company-PA-cocaine-crashing-car-spared-jail-excited-delirium-syndrome.html). She was described as behaving ‘erratically and in an obstructive manner’.
So it would appear that her excited delirium syndrome was accepted as mitigation. It seems that the accident itself was attributed to excited delirium syndrome, and this was accepted as a mitigating factor. The large bag of coke means that it is possible that what was represented to the court as excited delirium syndrome was a state, possibly a delirious form, of cocaine intoxication, although for some unexplained reason, she was not suspected of drug driving. But however caused, it is surprising that it was accepted as a mitigating factor. A reasonable person might have expected that the punishment should have been more severe for someone who uses cocaine and is at risk of accidents, or even just more at risk of such an accident, whether or not they use cocaine. Alcohol and drug intoxication in general are not regarded as mitigating factors, and if anything, may be regarded as aggravating factors.
I thought that, given the non-recognition of excited delirium syndrome by the World Health Organisation, the American Medical Association and the American Psychiatric Association, excited delirium syndrome would by now have been consigned to the waste bin of discredited syndromes along with parental alienation syndrome, gay bowel syndrome, Wilson’s temperature syndrome, wandering womb and others.
The Motor Insurers’ Bureau estimates that in the UK, approximately 300,000 vehicles are driven uninsured every single day. That probably means that there are in excess of 300,000 people in the UK driving without insurance. Once word gets around about this case, there will be such demand from defence lawyers that an enterprising forensic physician with appropriate marketing skills should be able to make enough money to retire early before it is realised that excited delirium syndrome is not a defence against driving without insurance and is more likely to be an aggravating than mitigating factor on sentencing.
In the meantime, serious readers are referred to:
Faculty of Forensic and Legal Medicine ‘Acute behavioural disturbance: guidelines on management in police custody’
Humphries, C., Aw-Yong, M., Cowburn, P., Deaking, C., Grundlingh, J., Rix, K., Stevenson, R., Veiraiah A, Walker, A. Acute Behavioural Disturbance in Emergency Departments: Best Practice Guideline. Version 2. Royal College of Emergency Medicine, October 2023.
Professor Keith Rix
MPhil, LLM, MD, FRCPsych, Hon FEWI, Hon FFFLM
Door Tenant, The Chambers of Mark Love, 2 Dr Johnson’s Buildings, Inner Temple
Visiting Professor of Medical Jurisprudence, Faculty of Medicine, Dentistry and Life Sciences, University of Chester
Honorary Associate Professor, Norwich Medical School, University of East Anglia