March 18, 2014

Shock therapy still given without consent

[Posted: Wed 12/03/2014 by Deborah Condon]

The number of mental health patients in Ireland who received electro-convulsive therapy (ECT) – formerly known as electric shock treatment – fell for the fifth year in a row in 2012, however almost 30 patients were still administered the treatment without their consent, the Mental Health Commission (MHC) has revealed.

ECT is a medical procedure during which an electric current is passed briefly through the brain via electrodes applied to the scalp. The patient is given a general anaesthetic, and muscle relaxants are also given to prevent the body from going into spasm.

The purpose of ECT is to treat specific types of major mental illnesses.

The MHC has just released data on the use of ECT and seclusion among the country's mental health inpatients in 2012. This revealed that 311 programmes of ECT were administered to 244 patients that year. A programme of ECT refers to no more than 12 treatments prescribed by a consultant psychiatrist.

According to the MHC, this marks a 6.3% reduction in the number of ECT programmes that were reported in 2011.

Patients receiving ECT ranged in age from 24 to 92 and almost two-thirds were women. The treatment was most commonly used to treat people with depressive disorders.

While most of these treatments were administered to patients with their consent, 27 patients did not give their consent, including four who were unwilling to consent. The others were unable to give consent.

In the vast majority of cases, some improvement was reported by the treating consultant psychiatrists. In almost four in 10 cases, full recovery was reported, while at least one in three reported significant improvement. No change or a deterioration was recorded in over 7% of cases.

Meanwhile the data also revealed that over 1,400 episodes of seclusion involving 505 patients were reported at 29 centres nationwide in 2012, a fall of 16% when compared to 2011.

Seclusion is defined by the MCH as the ‘the placing or leaving of a person in any room alone, at any time, day or night, with the exit door locked or fastened or held in such a way as to prevent the person from leaving'.

The majority of seclusion episodes in 2012 lasted less than eight hours, although a small number exceeded 72 hours. Two-thirds of these episodes involved men and over half of those place in seclusion were aged between 18 and 39.

Ten children were also secluded in 2012.

The highest number of seclusion episodes (231) was recorded at St Joseph's Intellectual Disability Service, followed by the Central Mental Hospital (133).

The data also noted that over 3,000 episodes of physical restraint were reported in 52 centres in 2012. These involved 933 individuals, including 42 children. Most of these episodes lasted five minutes or less.

The highest number of physical restraints (315) occurred in St Vincent's Hospital in Fairview in Dublin, followed by St Joseph's Intellectual Disability Service (244).

While the fall in the use of ECT and seclusion was welcomed by MHC chairman, John Saunders, he insisted that ‘further progress' could still be made.

"For example, while the number of those who do not consent to ECT treatment is in decline, it is still the commission's view that it should not be possible to administer ECT to a patient who is unwilling to receive it.

"Furthermore while progress has been made on seclusion and restraint we would like to see that number reduced further. These are emergency measures and should only be used in exceptional circumstances and only when in the best interests of the patient," he commented.

He added that the MHC will ‘continue to advocate for minimising the use of restrictive intervention and for the elimination of ECT provision to those who are unwilling to receive it'.