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PHR Welcomes BART (Bay Area Rapid Transit) Decision to End Use of “Excited Delirium” Diagnosis

Physicians for Human Rights (PHR) welcomes the decision by Bay Area Rapid Transit (BART) to remove the invalid diagnosis “excited delirium” from the BART Police Department policy manual and all written reports.  

BART’s policy change was informed by PHR’s 2022 report, “‘Excited Delirium’ and Deaths in Police Custody: The Deadly Impact of a Baseless Diagnosis,” which traced the history of “excited delirium,” its baseless scientific underpinnings and roots in anti-Black racism, and the profound harms caused by the continued use of the pseudoscientific phrase.  

BART’s announcement about the policy revision reads: 

“Physicians for Human Rights (PHR) (1997 Nobel Peace Prize Co-laureate) reconstructed the history of the term through a review of medical literature, news archives, and deposition transcripts of expert witnesses in wrongful death cases. PHR’s 2022 report concludes that the term ‘excited delirium’ cannot be disentangled from its racist and unscientific origins and therefore should not be cited as a cause of death. PHR found that ‘excited delirium’ is not a valid, independent medical or psychiatric diagnosis.” 

BART is one of the largest public transit systems in the United States, connecting San Francisco with the East and South Bays in northern California.  

“We applaud BART’s decision to abandon the use of ‘excited delirium’ and call on other law enforcement agencies around the country to follow their example,” said Joanna Naples Mitchell, PHR U.S. research advisor and co-author of the 2022 report. “Ending the use of this pseudoscientific term is an important first step and we urge BART to ensure full implementation of this change in policy and practice. ‘Excited delirium’ was dangerous and destructive from its inception in the 1980’s. It has no place in modern medicine or law enforcement.” 

“BART’s approach should become a model for other police departments to change their policies,” said Naples-Mitchell. 

PHR researchers concluded that “excited delirium” is scientifically meaningless because of the lack of consensus or rigorous evidentiary basis. PHR found that “excited delirium” does not have a clear or consistent definition, established etiology, or known underlying pathophysiology. Instead, “excited delirium” has become a catch-all, misleading explanation for many deaths occurring in the context of law enforcement restraint, often coinciding with substance use or mental illness, and disproportionately used to explain the deaths of Black men in police encounters.

Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.

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