ELECTROCONVULSIVE THERAPY (ECT) was performed on about 35 psychiatric patients who were either unwilling or unable to give their consent to treatment during 2010.
Overall, 347 patients received ECT in Ireland in 2010.
64 per cent were between the age of 18-64 years old. The average age for females was 59 and 60 for men.
The Mental Health Commission stated that 90 per cent of ECT programmes were administered to voluntary patients who consented to this treatment.
ECT, which involves sending an electrical current through the brain via electrodes applied to the scalp, can have beneficial effects on patients according to The College of Psychiatry. Many mental health campaigners argue that forced use of ECT is a human rights abuse resulting in severe memory loss.
However, the use of ECT has raised issues surrounding human rights, consent and the capacity of patients suffering with mental health problems.
If changes to the Mental Health Act 2001 are introduced, patients who do not give consent to ECT, may not be forced to have the treatment.
Minister of State with responsibility for Disability, Older People, Equality and Mental Health, Kathleen Lynch has flagged a number of aspects of the Mental Health Act that may be changed, namely the article 59b of the act, which states that the ECT can be given to an involuntary person who is “unwilling or unable”.
Currently a patient must consent to the treatment, but if they decide against treatment then that decision can be overridden if two psychiatrists believe it is in the best interests of the patient.
Minister Lynch told TheJournal.ie that she is of the view that in no circumstances should a patient who is capable of giving informed consent be forced to take treatment against their will, and accordingly, has accepted the recommendation of the steering group which reviewed the Mental Health Act.
Following their recommendation, the minister said that the term ‘unwilling’ should be removed from section 59 of the Mental Health Act 2001. This amendment will provide that where a person has the capacity to make the decision, any refusal to accept ECT will be respected.
However there is still some contention concerning the word “unable”. The Minister has stated that in regard to patients who are ‘unable’ to give consent will need further examination in the light of the proposed capacity legislation. She said she is confident that any shortcomings in the 2001 Act which arise because of capacity issues will be addressed by the proposed Assisted Decision- Making (Capacity) Bill which is currently being finalised by the Department of Justice and Equality.
The purpose of the proposed Bill is to provide a statutory framework governing decision-making on behalf of adults who lack capacity and will provide for the introduction of supported and substitute decision making for such adults.
David McCarthy from Mad Pride Ireland said that the removal of one word and the retention of another is simply “window dressing” adding that it was all just “semantics”.
She is maintaining the overall ethos of the act that enforces a psychiatrist’s power over the life of a patient. The psychiatrist is still left with the power over the individual. We have the case where a voluntary patient is voluntary up to the point where the psychiatrist can decide that a patient shouldn’t leave, even when a patient wants to, they can sign them over to be an involuntary patient and immediately they lose all their rights. That is still currently the situation and is upheld under the act.
Calling ECT a barbaric act, McCarthy said he was pushing for a full removal of ECT.
Andrea Ryder, External Affairs and Policy Manager at the College of Psychiatry told TheJournal.ie that she disagreed with Mr McCarthy stating “it is not semantics. What needs to be described is what “unable” means. The new capacity legislation will help determine what that is and what deems someone to be lacking in capacity and their ability to make a decision”.
She added that ECT is not the “barbaric” act that many think it is adding that most people think of the film ‘One Flew Over the Cuckoo’s Nest’.
It is in no way like the film. It is much more highly regulated. You have to have a nurse, an anaesthetist and consultant psychiatrist. Years ago it may have been different. Some of the views out there on ECT are based on experiences from 30 years ago and that is not to take away from bad practice then, but like any medical practice, the more time goes on the more we know about it.
Mary Maddock from Mindfreedom Ireland said she totally disagrees that the practice of ECT has changed much.
Speaking to TheJournal.ie, she said was diagnosed with bi-polar disorder and had ECT following the birth of her daughter in 1976. She said while doctors say that ECT is a last resort treatment, she was given the therapy just three days after having given birth.
She had it again in 1983, but said she is not sure how many sessions she received. She believes that psychiatrists are defending the use of ECT by stating that it has changed a lot over the last few years. “I am still hearing of cases where people are being forced to have ECT in the last year,” she said.
The first time I got electric shock therapy I don’t even remember having it. My husband Jim was consulted at the time, but I never gave consent, in fact I was never even asked. I didn’t even know what electric shock was at the time and either did Jim. No one told me what it was. Back then and still today, people give consent to things that are not explained to them. If you don’t have full knowledge of what you are consenting to you should not consent.
Ms Maddock said that removing the word “unwilling” still leaves the word “unable” which she said allows for psychiatrists to make the decision in a time of crisis. “The easy way for them to ensure that no one has it is firstly to introduce an advanced directive in which you can instruct someone that you never want ECT administered on you, that would be legal. At the moment you cannot make an advanced directive as it is not legal so is not worth the paper it is written on”.
Ms Ryder added that other treatments should be tried on that patient before ECT.
“ECT is a last resort, it should only be used when everything else has been tried, medication and therapy,” she said.
Mr McCarthy criticised the Minister for not being clear while appearing on TV3′s Tonight with Vincent Browne Show recently.
“She initially says that the patient’s wishes ‘will be taken into account’ put when pushed she said the patient’s wishes ‘will prevail’ so which one is it, it is simply a black and white issue.”
He argues that he would question the term “voluntary” in the Mental Health Commission’s figures stating:
The so-called voluntary decisions made for ECT – these patients are on a serious amount of psychotropic drugs. How voluntary that decision was can really be brought into question. If someone is brought into a facility and they are there for 6-9 months then they are on a cocktail of drugs , a psychiatrist comes in and explains ECT to you, and you agree. But then you can’t remember giving consent after. How voluntary those decisions are can be questioned.
The College of Psychiatry state in their position statement on ECT that they understand that ECT can raise people’s anxiety and fear.
They argue that while some people find it controversial ECT “is an important and necessary treatment for various serious psychiatric conditions, most commonly severe depression” adding there are “severely ill patients who will not respond to any other treatment”.
ECT is an “alternative effective treatment”.
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