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Acute behavioural disturbance: Guidelines on management in police custody

The FFLM has reviewed and revised this document after consultation with FFLM Members. The Guidelines represent the view of the FFLM following consideration of the evidence currently available. Forensic healthcare professionals (HCPs i.e. doctors, nurses and paramedics), should be aware of the guidance and take it fully into account when exercising their clinical judgement.

The FFLM recognises that this is an area of clinical practice that can be seen as being controversial, particularly with regards to terminology. The intention is to employ non-controversial and unambiguous terminology that is understood and accepted across the relevant professional groups and is non-discriminatory. The aim is to provide guidance which ensures that anyone, regardless of ethnicity, or any other protected characteristic, will receive the most appropriate care available. It is intended that the application of this guidance will reduce the need for force or restraint and ensure that where it is used the risks are minimised.

As with any clinical guideline, recommendations may not be appropriate for use in all circumstances. It is recognised that a limitation of a guideline is that it simplifies clinical decision-making and is not a substitute for clinical judgement. It is the HCP’s responsibility to ensure that recommendations are appropriate to the circumstances of the individual detainee and made in consultation with the patient and/or any guardian or carer.

The Royal College of Emergency Medicine has published ‘Guidelines for the Management of Acute Behavioural Disturbance (ABD)’ (2022)  to provide a guideline for Emergency Departments to safely and effectively manage individuals who attend or are brought in by the police/ ambulance personnel with suspected Acute Behavioural Disturbance. See here: https://rcem.ac.uk/wp-content/uploads/2022/01/Acute_Behavioural_Disturbance_Final.pdf

The Royal College of Psychiatrists has also recently published a Position Statement setting out the psychiatric perspective on ‘Acute Behavioural Disturbance’ and the management of people who are severely agitated, distressed and at risk of a physical health emergency outside of mental health settings: ‘Acute Behavioural Disturbance’ and ‘Excited Delirium’. Position Statement PS02/22