New ECT advice
weak, says Sainsbury Centre for Mental Health
3, 2003 - Source:
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.
Muijen, chief executive of the Sainsbury Centre for Mental Health
(SCMH), said the guidelines published last month by a NHS watchdog
were "incredibly predictable".
national institute for clinical excellence (Nice) said electroconvulsive
therapy should only be used to treat people with mental health problems
as a last resort.
added that ECT should be restricted to patients with severe depression,
catatonia and prolonged or severe manic depression.
Mr Muijen said: "This is pretty much accepted as good practice.
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
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
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."
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.
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.
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
mental health charity Mind welcomed the guidance but called for
legislation to guarantee a patient's right to refuse the treatment.
Brook, the chief executive of Mind, said: "The administration
of ECT has been stuck in the dark ages for too long.
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.
to the current Mental Health Act are essential in order to provide
a legal framework in which they can be enforced."
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.
treatment - made notorious by the film One Flew Over the Cuckoo's
Nest - involves delivering an electric shock to the brain.
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.
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.
the RCPsych has announced plans to introduce a new accreditation
scheme for ECT clinics across Britain and Ireland in a bid to raise
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