A man who died after being restrained by five police officers, mostly face down on the ground, for almost an hour after a 999 call reported he was ‘acting strangely’ is one of more than 40 in Britain whose death was subsequently attributed to a disputed medical condition.
Body-worn camera footage captured 32-year-old Krystian Kilkowski, an engineer from Poland, saying he feared he was going to die when police detained him outside his home in Diss, Norfolk, in August 2020.
By the time an ambulance arrived, he was breathing and covered in blood, having bitten his arms and tongue in distress. A 2022 inquest later found he had used amphetamines, but not a lethal dose, and that “serious failures” in the use of restraint by Norfolk police contributed to his death.
The Independent Office for Police Conduct recommended further training but cleared the officers of any blame, saying in its report that Kilkowski suffered from “acute conduct disorder” (ABD).
His death was listed on his death certificate as “drug-related,” with ABD – aggravated by “physical activity” and police restraint – listed as a contributing factor.
But the label is hotly contested within medicine, is rooted in pseudoscience and is not a diagnosis recognized by the World Health Organization. The original evidence on which the ‘condition’ was based – which claimed that 32 black women found dead in Miami in the 1980s had suddenly dropped dead after falling into a state of ‘excited delirium’ due to sex and cocaine – has been debunked as pseudoscience after it turned out they were in fact murdered.
Yet the reference to the condition, now better known in Britain as ‘acute conduct disorder’, has remained controversial. It is now most commonly used to describe people who are irritable or behaving bizarrely, usually due to mental illness, drug use, or both. According to guidelines from the Royal College of Emergency Medicine, ABD is an umbrella term used to describe a presentation characterized by symptoms such as insensitivity to pain, increased strength and increased heart rate.
In recent years, the labels have come under increased scrutiny. In the US, ‘excited delirium’ (ED) emerged as an issue during the trial of police officers involved in the killing of George Floyd, following controversial suggestions that he was suffering from it at the time of his death.
A podcast from a journalist in January Jon Ronson Things fell apart, detailed how police and lobbyists in the US have used “excited delirium” as an explanation in court following the deaths of hundreds of people who have been tasered over the years. The American Medical Association and other influential health organizations have rejected the terms as a cause of death or diagnosis, following concerns that they were being used to “explain away” police involvement.
Campaigners fear a similar pattern in Britain, where ABD is routinely cited as a factor in sudden and mysterious deaths following police contact – mainly of black men and people from ethnic minorities.
According to research by the charity Inquest, the Royal College of Psychiatrists and the Observer, even as recently as last month. Deborah Coles, executive director of Inquest, said it had “without doubt” been used in some cases to downplay the “inherently dangerous” use of restraint.
Her fears are shared by Stephen Ball, whose son Joshua Ball, 26, died after being restrained in 2018. Before handcuffing him and placing a spithood over his head, Staffordshire Police discussed whether he had ABD or ED and noted that he was presenting. in an agitated state, with incoherent speech and high body temperature.
Ball had been using cocaine at the time, was behaving bizarrely and was bleeding with an injury to his stomach after a member of the public threw a rock at him. The police log for the incident referred to ‘excited delirium’ and added: ‘He is very irritable and does not believe he is life threatening.’
Ball, a father-of-one described by his family as a ‘cheeky guy’, later suffered two cardiac arrests. An inquest concluded that the stone injury and cocaine use were likely the cause, but highlighted concerns about “inappropriate police conduct and the use of a spithood”. The police watchdog report, which referred to ABD, referred one officer for further training but found there was no disciplinary matter to respond to, concluding that the use of force was “necessary, reasonable and proportionate”.
Stephen Ball said he feared ABD and ED would give police a “blinding excuse to go too far” with the use of force, under the guise of preventing harm. “It gives the restraining orders an excuse of, ‘What else can we do?’” he said. “My first and only glimpse of Joshua on video told me he needed medical attention and no further violence or physical restraint.”
Staffordshire Police said Ball’s death was ‘untimely and tragic’. Regarding references to “excited delirium” in police logs, it stated: “We have not used the term ‘excited delirium’ for some time. Now the phrase ’emotionally or mentally disturbed’ is used, referred to in the College of Policing guidelines, which describes individuals who may behave in an unexpected, extreme or challenging way as a result of a mental health problem or emotional distress, or which can sometimes be caused by self-medication.”
Acute behavioral disturbances were also referenced in the case of Mouayed Bashir, a 29-year-old man of Sudanese descent who died after being held in the bedroom of his family home in Newport, South Wales, in 2021. Observer after the inquest into Mouayed’s death last month, his family described him as a “sweet” and cheerful hip-hop lover who cared for his impoverished mother and dreamed of opening his own restaurant.
In the days before he died, he had suffered from deteriorating mental health, which spiraled on the morning of February 17, 2021, after he took cocaine. His parents called a GP and then 999 for help. The police arrived before the ambulance.
Officers later said they feared Mouayed, who had previous convictions for possession of cannabis and pepper spray, was armed. But when they entered his room, they found him lying on the floor in his underwear, kicking out of them, and said it appeared he was suffering a “mental episode.” They handcuffed him, tied his ankles and knees, and restrained him as he trembled, moaned and screamed.
Mouayed’s health, including his oxygen levels, deteriorated and he fell unconscious. He later suffered cardiac arrest. The inquest concluded that he had used “an unknown amount of cocaine, which caused him to develop symptoms consistent with ABD”. The use of force was found reasonable by the IOPC.
Before Mouayed was restrained, and on subsequent incident reports, officers said they believed he had ABD. Mouayed’s brother, Mohannad Bashir, 35, said there was “no accountability” after Mouayed’s death, and that he needed medical attention rather than restraint.
He said he was concerned that ABD could be used as a “shield” or “cover for mistakes”, and called for a review of its use. “It’s a pattern. “Many young black men who die under police supervision fall into the ABD category,” he said. “They treated him like a criminal, not like a person in desperate need.”
