Meaningful change requires thoughtfulness, leadership and care — virtues we all value in our public servants and expect from our government. The BART Police Department’s, or BART PD’s, recent elimination of the phrase “excited delirium” from its policies and reports was only possible through a collaborative effort between BART PD and those of us providing independent civilian oversight. This wasn’t “wokeness” run amok. It was a good-faith effort by all parties to eliminate the use of a term with a racist history.

I am the senior investigator of the BART Office of the Independent Police Auditor, or OIPA, and I spearheaded our most recent policy research and revision recommendation. My experience in independent civilian oversight spans almost two decades in the Bay Area.  Our role and legislative mandate require us to hold the BART PD accountable when officer misconduct occurs. I have conducted investigations, interviewed officers and recommended discipline pursuant to this mandate in the name of public transparency and accountability. By its very nature, our work is often perceived as adversarial.

OIPA is independent of the police department and separate from the volunteer, community-led BART Police Citizen Review Board, or BPCRB. The BART oversight model ensures the BPCRB and OIPA serve as a check and balance to one another and provide an avenue for members of the public to have a voice in the process of accountability and the ability to improve community trust in BART PD. 

The initiative to remove the term “excited delirium” from the department’s policy manual and from future police reports was an effort to be proactive in addressing race and equity in policing. What initially began as a conversation about an American Medical Association press release analyzing the nation’s growing dissatisfaction with the police became a discussion about BART’s commitment to progressive policing and fighting racism. 

In March 2022, a Physicians for Human Rights report exposed the term’s racist history and traced its use to find its roots in racial stereotypes perpetuated by law enforcement to absolve officers of responsibility. Historically, this term was applied to cases with excessive use of force, officer-involved shootings and in-custody deaths of Black people and other people of color.

A cooperative approach is necessary to address complex systems of racism and to mitigate the disparate outcomes for the many community members who suffer from mental illness, drug addiction and houselessness in the Bay Area. BART PD has had its fair share of such contacts and has firsthand knowledge of what can occur.

According to a 2020 Pew Research Center poll, only 35% of Americans believe American police do an excellent or good job of using appropriate policing force and treating racial and ethnic groups equally. BART PD has acknowledged its responsibility to improve its approach and embraced the opportunity to implement more equitable policing practices with this policy change.  BART itself has also committed to implementing racially equitable practices in connection with all of its work.

Additionally, some law enforcement advocates identified the need to work cooperatively with the medical community to help prevent in-custody deaths. These advocates are concerned not only about liability and officer safety, but also about the preservation of life. I believe this is where OIPA and BART PD found our common ground. 

My policy research included a review of BART PD’s 2021 police reports to locate all uses of the term “excited delirium.” In each report, there was a narrative description of what the officer observed and the actions taken.

In one report, a person was described as “sweating profusely, talking fast and could not stand still.” Additional details described how the subject was “combative” and “experiencing a psychotic episode due to illicit drug use,” and “excited delirium” was cited as a diagnosis. Because the officers’ reports clearly described their observations, the use of the phrase “excited delirium” was unnecessary. 

Once the data were compiled, OIPA met with the BART PD deputy chief in charge of the department’s Progressive Policing and Community Engagement Bureau. Initially, BART PD representatives identified areas of disagreement with some of the language in the study and press release, but we focused on the areas where there was agreement — agreement that the term was historically racist, nonmedical and failed to add substantive value in reports.  

When OIPA ultimately recommended policy changes to the BPCRB and BART PD Chief Ed Alvarez, we understood that there were significant points of agreement. After a presentation of the recommendations to the BPCRB chair, Alvarez codified the work and implemented the policy manual revision.

As a result, BART PD is the first law enforcement agency to adopt such a change in connection with the term “excited delirium,” and our system of checks and balances clearly functioned as intended.  After all, this change is a relatively common-sense improvement considering the polarizing rhetoric often used to describe policing tactics. 

While there is still more to be done to improve policing, this small policy revision demonstrates the ability of a research team, a police department and a robust civilian oversight model to do what is best for the health of a community — work collaboratively to save lives and improve government for the people.