Expert explains why 'excited delirium' shouldn't be used as a diagnosis in police-involved deaths

IIO director to testify at Myles Gray inquest The head of B.C.’s police watch dog and a pathologist are expected to testify at the coroner’s inquest into Myles Gray’s death.

"Excited delirium" has been used to describe a person’s delirious or erratic behaviour as the determinant factor for a cause of death in incidents involving first responders, but one expert explains why he thinks it’s not only wrong as a “diagnosis,” but could be harmful.

Forensic psychiatrist and President of the Canadian Psychiatric Association Gary Chaimowitz says it shouldn't be considered the final cause in cases where restraint or aggressive force by police, for instance, could be the cause of death.

"From a psychiatric perspective, no, it is not not a valid diagnosis," Chaimowitz told CTV's Your Morning on Tuesday. "Excited delirium is not a particular condition, it describes a set of behaviours, and that should not be the diagnosis because there are many other reasons why somebody may have died while being restrained by those responders."

Recently, the British Columbia Coroner's service began an inquest into the death of Myles Gray, a Vancouver man who died during an altercation with police in 2015. His family has been calling for criminal charges for the police involved, as witnesses report seeing Gray acting erratically and standing on a street corner before police arrived. His family said he needed help and compassion during a "vulnerable" moment.

The 2016 death of Ontario man Abdirahman Abdi was also called into question after he died during a physical altercation with police. The court ruled, because of his underlying heart conditions, his death was caused by hypoxic brain injury followed by a heart attack. The police officer involved was charged with manslaughter and found not guilty. In 2021 his family reached a confidential settlement with Ottawa Police Services.

Chaimowitz says the use of excited delirium as a cause of death can be particularly harmful towards Black, Indigenous and people of colour, who are often overly-represented with the term in police-involved incidents.

The Tracking (In) Justice data set of police-involved deaths in Canada, collected by the Canadian Civil Liberties Association and several Canadian universities, found that racial disparities in the criminal justice system and police-involved deaths have been rising equally in the last two decades. Deaths from police use of force grew from 22.7 per cent between 2000 and 2010, to 37.8 per cent between 2011 and 2022.

Among the disparities, the tracker says Black people die at a rate almost six times higher in comparison to white people; while Indigenous people die at nearly eight times the rate of white people.

With several U.S. medical and psychiatric associations no longer recognizing excited delirium as a cause of death, Chaimowitz says this shift can lead to focusing on other factors like discrimination and racism that may affect the over-representation of people of colour in police-involved deaths.

"I think there's been an attempt to look at that, to see whether structural racism may have been a part of why that group is so highly represented in so-called excited delirium cases," he said.

Despite this, the Canadian Police Knowledge Network (CPKN) provides a course on excited delirium and describes it as "a condition identified by medical experts, account(ing) for the majority of custody-related deaths." The course says it intends to educate officers to identify this behaviour that is driven by the use of drugs like crack cocaine or methamphetamine by the person in custody.

Chaimowitz says, while it's possible for a person using drugs to go into cardiac arrest during an altercation with police, this isn't always the case and there needs to be better education and training for police when interacting with people in crisis.

"I think there needs to be a governmental sort of oversight of these sorts of cases to try and unpack exactly what happens when somebody, for instance, with a mental disorder comes into contact with police or first responders, and there's been a negative outcome," he said.

With files from CTV News Ottawa and CTV News Vancouver