National Institute for Health and Care Excellence
Other
Action Planned
NICE acknowledges concerns about the need for guidance on acute behavioral disturbance (ABD) and will consider this in a future update to its guideline on violence and aggression (NG10). (AI summary)
View full response
Dear Ms Knight,
I am writing in response to your correspondence, dated 20 February 2020, regarding the death of Jon David James. I was very sorry to read of Mr James’ death.
We have reflected on the circumstances surrounding Mr James’ death, and your concern that publication of guidance on acute behavioral disturbance (ABD) would benefit in preventing future deaths.
NICE has published a guideline on violence and aggression: short-term management in mental health, health and community settings (NG10) which covers the the short-term management of violence and aggression, and aims to safeguard both staff and people who use services by helping to prevent violent situations and providing guidance to manage them safely when they occur. It is relevant for mental health, health and community settings. The guideline does not focus on the very specific condition of acute behavioural disturbance (ABD), also known as ‘excited delirium’. However, there is a reference to the latter within recommendation 1.5.5 which says:
1.5.5 Healthcare provider organisations should train staff in emergency departments to distinguish between excited delirium states (acute organic brain syndrome), acute brain injury and excited psychiatric states (such as mania and other psychoses).
I am aware that the Royal College of Emergency Medicine has published guidelines for the Management of Excited Delirium / Acute Behavioural Disturbance (ABD). This publication covers the early recognition, intervention and proactive treatment of ABD.
Our guideline on violence and aggression (NG10) is due to undergo a full update in due course and your concerns have been noted for further consideration by the guidelines team as part of this work, including whether it is appropriate for the scope of NG10 to be extended to cover ABD, and any necessary clarification to the terminology in recommendation 1.5.5.
I am writing in response to your correspondence, dated 20 February 2020, regarding the death of Jon David James. I was very sorry to read of Mr James’ death.
We have reflected on the circumstances surrounding Mr James’ death, and your concern that publication of guidance on acute behavioral disturbance (ABD) would benefit in preventing future deaths.
NICE has published a guideline on violence and aggression: short-term management in mental health, health and community settings (NG10) which covers the the short-term management of violence and aggression, and aims to safeguard both staff and people who use services by helping to prevent violent situations and providing guidance to manage them safely when they occur. It is relevant for mental health, health and community settings. The guideline does not focus on the very specific condition of acute behavioural disturbance (ABD), also known as ‘excited delirium’. However, there is a reference to the latter within recommendation 1.5.5 which says:
1.5.5 Healthcare provider organisations should train staff in emergency departments to distinguish between excited delirium states (acute organic brain syndrome), acute brain injury and excited psychiatric states (such as mania and other psychoses).
I am aware that the Royal College of Emergency Medicine has published guidelines for the Management of Excited Delirium / Acute Behavioural Disturbance (ABD). This publication covers the early recognition, intervention and proactive treatment of ABD.
Our guideline on violence and aggression (NG10) is due to undergo a full update in due course and your concerns have been noted for further consideration by the guidelines team as part of this work, including whether it is appropriate for the scope of NG10 to be extended to cover ABD, and any necessary clarification to the terminology in recommendation 1.5.5.