New ECT advice weak, says Sainsbury Centre for Mental Health

May 3, 2003 - Source: http://society.guardian.co.uk

New official guidance on electric shock therapy fails to a deal with severely mentally ill people who refuse the controversial treatment, according to a mental health charity.

Matt Muijen, chief executive of the Sainsbury Centre for Mental Health (SCMH), said the guidelines published last month by a NHS watchdog were "incredibly predictable".

The national institute for clinical excellence (Nice) said electroconvulsive therapy should only be used to treat people with mental health problems as a last resort.

It added that ECT should be restricted to patients with severe depression, catatonia and prolonged or severe manic depression.

But Mr Muijen said: "This is pretty much accepted as good practice.

"I find the guidance very weak. It doesn't deal with what to do when someone is in a life-threatening situation and refusing treatment. For example, when a patient won't eat because they think the devil is inside them and the psychiatrist wants to keep them alive against their wishes.

"The guidance states that patients can make advanced directives to refuse treatment but these have no legal basis. A psychiatrist knows that in such cases the patient usually recovers after four sessions of ECT and will get a second opinion and go ahead despite the patient's decision."

But the chief executive of Nice, Andrew Dillon said: "Today's guidelines will help patients, and those who treat them, better understand the benefits and risks of ECT and in doing so reduce the uncertainty surrounding the use of what has been a controversial technique."

The institute, which decides which health treatments and technologies should be available on the NHS, said that ECT should only be used in the short-term when other treatments, such as medication and psychotherapy, had proved ineffective.

It rejected calls by the Royal College of Psychiatrists (RCPsych) for ECT to be made available for patients with less severe depression and those with schizophrenia.

The guidelines also state that doctors must warn patients of the potential side effects of ECT, which include memory loss and in rare cases facial paralysis, and ensure that they consent to the treatment where possible.

The mental health charity Mind welcomed the guidance but called for legislation to guarantee a patient's right to refuse the treatment.

Richard Brook, the chief executive of Mind, said: "The administration of ECT has been stuck in the dark ages for too long.

"We are pleased that some measures have been taken to address patients' needs, but we still want to see robust safeguards that will prevent people from being given ECT when they are opposed to it.

"Revisions to the current Mental Health Act are essential in order to provide a legal framework in which they can be enforced."

ECT has been administered in the UK for more than 60 years. While the procedure is now far less commonly administered, approximately 22,000 received it last year.

The treatment - made notorious by the film One Flew Over the Cuckoo's Nest - involves delivering an electric shock to the brain.

Patients first receive a general anaesthetic and a muscle relaxant before a current is administered via electrodes for three to four seconds. This provokes an epileptic seizure, which is supposed to restore the natural chemical balance of the brain.

The effectiveness of the treatment has long been the subject of a bitter dispute between psychiatrists and mental health service users. While regarded as a lifesaver by most psychiatrists, many former patients believe ECT is barbaric and has ruined their lives.

Meanwhile the RCPsych has announced plans to introduce a new accreditation scheme for ECT clinics across Britain and Ireland in a bid to raise standards.

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