Lake Alice: the West Malling connection

In my last post I mentioned that Selwyn Leeks, who ran the child and adolescent unit at Lake Alice Hospital in New Zealand, had a great-grandfather who was the proprietor of a private asylum in West Malling, Kent, England. In fact, the licence for the asylum was held at different times by Leeks’ great-grandfather, his great-grandmother, his great-great-grandfather and his great-great-grandmother. (In those days women, although not allowed to enter the medical profession, could hold asylum licences, just as they could hold licences of beerhouses and public houses.)

Anne Goad has recently written a PhD thesis that “examines lunacy provision in Kent between 1774 and 1874 from the perspective of the anti-psychiatrists of the 1960s and 70s.” (Managing the Mad: Lunacy Provision and Social Control in Kent, 1774–1874, Anne Elizabeth Goad, Submitted in partial fulfilment of the requirements of the degree of Doctor of Philosophy at Queen Mary University of London in September 2020). The author has herself experienced psychiatric treatment in Kent:

“In this thesis I have found it helpful and productive to use my modern experiences to examine and understand the nineteenth century context. Thus regarding the role of staff I found the maintenance of order far more important than any show of empathy. Mental health nurses facilitate the smooth running of the ward and ensure patients dress, eat and attend doctors’ appointments where instead of understanding they are once again fobbed off with often large doses of mind-altering medication.” (page 14)

The thesis is dedicated to, amongst others, my great-great-grandfather who spent some time in Barming Heath, the public asylum in Kent:

“This thesis is dedicated to all the patients incarcerated in the Kent County Lunatic Asylum at Barming Heath from its opening in 1833 to 1874, especially those whose names feature in the text.” (page 5)

Presumably my ancestor was not interesting enough to feature in the text. 

The thesis contains a 17 page section on West Malling asylum (pages 39-56). It was set up in the 1760s by the influential physician William Perfect, who was not an ancestor or blood relative of Leeks. Goad describes how Perfect used galvanic electrical treatment in his asylum:

“Also a novelty in the eighteenth century was the use of electricity to treat lunatics and Perfect owned a machine which he made use of when all other treatments had failed. He described some cases of treatment by electricity in the latter chapters of Annals of Insanity, suggesting his acquisition of the device was made towards the close of the century. Although he conceded that electricity afforded usually only partial or temporary relief, he gave details of three cases where the cure had been total. Thus, Mrs E.W., who had been reduced to a miserable state of melancholy by the death of her husband, had not responded to any of the usual methods of treatment. Electricity was tried as a last resort with shocks passed through her cranium once a day for a month. This produced an improvement, allowing the patient to dress and feed herself. The shocks were then increased every second, third or fourth day, but not confined to the head, for a month longer, after which she was released home cured with no return of her disorder.” (page 41)

Goad traces a line, albeit not a straight one, from these early experiments with electricity to the invention of electroconvulsive therapy (ECT) by Cerletti and Bini in 1938. (page 41-42)

After Perfect’s death, the West Malling asylum passed into the hands of his son George, who became bankrupt in 1815, and the asylum was then bought by Leeks’ great-great-grandparents Jane and Robert Rix. Jane had worked as an attendant at the asylum for 25 years. (page 49-50) 

Jane and Robert’s daughter, Mary Ann Rix (Leeks’ great-grandmother) married William Perfect’s grandson and was widowed young. In 1850 she married naval surgeon Thomas Harvey (Leeks’ great-grandfather), whose father, James Lowry, originally from Ireland, was also a naval surgeon. James Lowry left a memoir of his naval service, which has recently been published by descendants under the title of “Fiddlers and Whores”. Leeks’ grandmother, Minnie Lowry, was born in 1861.

It was while Jane Rix (Leeks’ great-great-grandmother) held the license, in 1844, that the West Malling asylum was criticised by the Metropolitan Commissioners in Lunacy, when an inspection discovered six patients sleeping in an outhouse. This episode “gave rise to section 63 of the Lunatics Act 1845 which made it an offence to conceal from or neglect to show to the visitors any part of a licensed house.” (page 52)

The 1881 census sees Leeks’ grandmother, 19-year-old Minnie Lowry, living in the asylum with her father and stepmother. (It was common practice in those days for the proprietors of private lunatic asylums to live on the premises.) Patients included two clergymen, a solicitor, a sculptor, a silk merchant, an army captain, and a shipbuilder.

In 1883 Minnie Lowry married her first cousin, Edward Lowry Leeks. Edward was the son of a solicitor and had entered the Middle Temple after graduating from Trinity Hall, Cambridge. But he evidently decided the law was not for him, as his occupation is given as medical student on the 1881 census. He doesn’t appear to have become a doctor either, and describes himself as “gentleman” on his marriage certificate. At some time between 1883 and 1896 Minnie and Edward emigrated to New Zealand; a bankruptcy notice sees them living in Masterton in 1996, with Edward’s occupation given as clerk. An article about the bankruptcy in the Wairarapa Daily Times (13 March 1996) said that Edward had “never had permanent employment since he came to the colony”. The couple had two daughters, one of whom died in infancy, and eight sons. Three sons, and their son-in-law, were lost in WWI.

Had Leeks, I wonder, heard stories as a small boy from his grandmother about growing up in the family asylum, stories that might have inspired him to take up psychiatry – with such disastrous results?

Posted in ECT and young people, Legal cases, Miscellaneous | Leave a comment

Lake Alice: who was Selwyn Leeks?

Who was Selwyn Leeks, the psychiatrist who ran the Lake Alice child and adolescent unit during its short existence from 1972 to 1978? Was there, I wondered, anything in his background that would throw light on his subsequent career and mistreatment of child patients?

Leeks, who is aged 92, was born in 1928 or 1929. He appears to have come from a modest background; his father, who died when Leeks was a young man, was a carpenter. His paternal grandparents however, who had emigrated to New Zealand from England, both came from quite wealthy families. Leeks’ great-grandfather, Thomas Harvey Lowry, was a physician and proprietor of a private lunatic asylum in West Malling, Kent. Leeks’ wife, Priscilla Morgan, came from a family of doctors on her mother’s side. Both Leeks and his wife had lost a brother in WWII.

According to the New Zealand Medical Register, Leeks graduated in medicine in 1960 and obtained his conditional registration in 1961. By the time he graduated he was in his early thirties and already married with a daughter (two more daughters would follow). What had he been doing before studying medicine? He appears to have alternated time spent at University with time spent working as an insurance clerk.

In 1950 he featured in the Otago Daily Times (17 April) under the heading “Student injured at rugby”

“Head injuries and concussion were received by Selwyn Leeks, a student at Carrington Hall, aged 21, while he was playing Rugby football on Saturday for the University C Team in a match against Training College at the University Oval. It is understood that Leeks was knocked out in a scrum. He was admitted to Dunedin Public Hospital at 4.45 pm on Saturday, and last night his condition was reported to be satisfactory.”

Is it possible that this head injury could go some way towards explaining his subsequent behaviour? 

The electoral roll shows the family living at Hawkes Bay Memorial Hospital in 1963 and then Leeks spent some time in England. I have only been able to find one sighting of him in England, and that was in the British Journal of Psychiatry in April 1971 when he was listed as having become a member of the Royal Medico-Psychological Association. He was described as an assistant psychiatrist at Shenley Hospital in Hertfordshire. However, by the time the list was published, he was back in New Zealand. The Manawatu Heritage website, where there is a photograph of a smiling Leeks, says: 

“Dr Leeks took up employment with the Palmerston North Hospital Board in January 1971, after returning to New Zealand from studying overseas. As part of his work, Dr Leeks was in charge of the adolescent unit at Lake Alice mental hospital. In January 1978, Dr Leeks left Palmerston North to go to Melbourne to take up a position as a child psychiatrist.”

He left without his wife, who stayed in New Zealand. 

Leeks appears to have published very little; I could only find one case report about something unrelated to his time at Lake Alice. So it is impossible to say where his ideas about giving young people ECT or painful electric shocks came from. I did however find him quoted as saying: “If you want to get people back as economic units of society then you get on with treating them — you don’t play therapeutic games with them.”*

Was this what he was trying to do at Lake Alice? If so, he was singularly unsuccessful. He should have heeded the proverb, “Physician, heal thyself”. Investigations and inquiries don’t come cheap, quite apart from the 12.8 million NZ dollars paid out in compensation to survivors of Lake Alice. If you must reduce people to economic units of society, then Leeks definitely comes out on the debit side.

*New Zealand Herald, 20 December 1976, quoted in Hilary Haines, Women, psychiatry and shock treatment, Broadsheet, April 1978 

Posted in 1970s, ECT and young people, ECT worldwide | 1 Comment

Lake Alice: history

In June 2021 the Royal Commission of Inquiry into Abuse in Care in New Zealand between 1950 and 1999 spent two weeks hearing evidence about what occurred at the Lake Alice Child and Adolescent Unit in the 1970s. 

“The Inquiry will investigate what happened to children and young people at the unit, and why it happened. It will investigate what the Government, Police and professional bodies did to prevent and respond to abuse of children and adolescents in the unit.”

Lake Alice (1950-1999) was a rural psychiatric hospital near the town of Bulls in the Rangatikei district of the Manawatū-​Whanganui region of New Zealand’s North Island. In 1987 it had 250 patients. It included a maximum security unit and, from 1972-1978, a unit for children and adolescents, run by Dr Selwyn Leeks. The unit was described by MP Jonathan Hunt in House of Representatives in 1977:

“The unit is housed in an old building which has been adapted for children. It does not give the appearance of being a supportive environment for severely disturbed children. It is staffed by a psychiatrist, Dr Selwyn Leeks, employed by the Palmerston North Hospital Board; a psychotherapist employed full-time – Mrs Priscilla Leeks; three other therapists, who do eight part-time sessions; and 8 nurses rostered to care for 46 children…. The unit was opened in 1972 with 12 beds, and now caters for 46 disturbed children aged between 8 and 15 – which makes it the largest residential unit in New Zealand. It takes patients on a national basis. One-fifth of the children are psychotic, one-third are neurotic, and the rest are behaviourally disturbed, according to statements made by Dr Leeks in the Auckland Star on 15 December 1976. The majority of the children are in the unit because of family problems, expulsion from schools, and what are referred to as ‘character disorders’.”

As early as 1974, concerns had been raised by an educational psychologist, Craig Jackson, about the use of ECT at the unit. The Royal Commission heard how the superintendent of Lake Alice Hospital, Dr Sydney Pugmire, had responded with a letter to Craig Jackson’s boss, the chief educational psychologist, saying he had investigated the unit’s therapeutic techniques and found the “anxieties of the educational psychologists were completely unfounded”. However he said that Dr Leeks had agreed to discontinue the use of ECT without anaesthesia and the use of ectonus (a technique which delivered smaller, painful, sub-convulsive shocks). Craig Jackson continued to raise concerns about the punitive use of ECT at the unit.

In 1976 the media were calling for an investigation into the unit. In 1977 there was an inquiry by magistrate William  Mitchell into the treatment of a Niuean boy, who had been given ECT both with and without anaesthesia at Lake Alice. The report exonerated the staff at Lake Alice, saying that the treatment was necessary because of the boy’s “acute psychotic depression”. 

The Mitchell Report was quickly followed by a report by ombudsman Sir Guy Powles into the treatment of a 15-year-old boy at the unit. This report was more critical of the treatment given at the unit, saying that the boy had been subjected to a “grave injustice” and that ECT should only be used in exceptional circumstances, and with anaesthesia.

Meanwhile the Medical Council investigated a complaint against Leeks but took no action against him. The unit was closed in 1978, Leeks having moved to Australia, taking with him a certificate of good standing from the Medical Council.

In the 1990s two former patients of the Lake Alice unit took legal action and were eventually awarded an out-of-court settlement. In the meantime a class action had been initiated and an apology and ex-gratia payment was given to 95 former patients. Judge Sir Rodney Gallen was appointed to apportion compensation between claimants and wrote a damning report about the unit. The government tried unsuccessfully to prevent publication of the report.  A further group of claimants came forward and also received settlements. In all $12.8 million in compensation was paid to 195 victims, although some of this money went to lawyers.

The police decided in 2010 to take no action against former staff at Lake Alice, including Leeks. But a survivor took their case to the United Nations Committee on Torture, whose report persuaded the New Zealand Government to re-open the case and include a case study of Lake Alice in the Royal Commission of Inquiry into Abuse in Care.

In future posts I will look at testimony given to the Royal Commission, and at the career of Selwyn Leeks.

The information in this post comes from:

House of Representatives Parliamentary Debates 1977 pp 416-17

David Williams: First they were tortured, then the state failed them, 28 June 2021, Newsroom website

Anniversary of United Nations Committee against Torture decision, 23 January 2021, NZ Human Rights Commission

Posted in 1970s, ECT and young people, ECT in the media, ECT worldwide, Legal cases | Leave a comment

ECT: what do you wake up from?

When someone undergoes electroconvulsive therapy (ECT), what do they wake up or come round from afterwards? Some patient information leaflets are explicit: 

“They [qualified staff] can help you with the process of waking up from the anaesthetic…” (Royal College of Psychiatrists 2020 leaflet)

“After your treatment, and while you’re still under the anaesthetic, you’ll be moved to the recovery area. You’ll be given oxygen and monitored closely by a nurse until you come round from the anaesthetic safely.” (Southern Health NHS Foundation Trust leaflet)

“You will then be moved to the recovery ward to wake up from the anaesthetic… “ (The Royal Australian & New Zealand College of Psychiatrists leaflet)

At first sight it makes sense. We are all familiar with the concept of anaesthesia: you are given an anaesthetic, have your medical procedure and then come round from the anaesthesia. Why should ECT be any different?

I was left pondering this question after reading an article published in the British Journal of Psychiatry in 1968 (“A comparison of techniques in electro-convulsive therapy” by M. Valentine, K.M. Keddie and D. Dunne) which compared bilateral/unilateral and sinewave/brief pulse ECT. The patients being given bilateral sinewave ECT took four times as long to regain consciousness as those being given unilateral brief pulse ECT. If it had been the anaesthetic keeping them unconscious, then there would have been no difference between the groups.

In fact, the anaesthetic is only intended to keep you unconscious for just long enough to administer a muscle paralysing drug and electric shock. This is made clear in an ECT policy document from Western Health and Social Care (Northern Ireland) when it says, in the section on anaesthetics, that further anaesthesia may be required if the first electric shock does not produce a seizure:

“If the response to stimulation is not sufficient then the psychiatrist may wish to restimulate. This may require a further bolus of Propofol and may require another bolus of Suxamethonium if spontaneous ventilation has returned”.

In the section on guidance for nursing staff, however, the document reverts to the usual talk about coming round from the anaesthetic:

“Once the patient has come round from the anaesthetic they hand the care of the patient back to the escort nurse.” 

When ECT is given without anaesthesia there is still a period of unconsciousness following the seizure. Writing in the journal Heart in 1948, R. Kauntze and G. Parsons-Smith say: “consciousness is recovered in from four to fifteen minutes minutes – a consciousness clouded by disorientation and amnesia.”

Quite what you call this period of unconsciousness following the electric shock and seizure, I don’t know – a post-ictal coma, or post-ictal state? Whatever you call it, the question arises: why have psychiatrists tried to write it out of descriptions of ECT?

Posted in 1940s, Miscellaneous, Techniques | 2 Comments

ECT patient information leaflets

Psychologist Christopher Harrop and colleagues have recently (June 2021) published an article in the journal Ethical Human Psychology and Psychiatry: “How accurate are ECT patient information leaflets provided by mental health services in England and the Royal College of Psychiatrists? An independent audit.”*

The authors looked at 36 patient information leaflets about electroconvulsive therapy (ECT) that they obtained via the Freedom of Information Act. A further 15 trusts that use ECT did not, for one reason or another, provide a leaflet. They also looked at two leaflets (2019 and 2016) from the charity Mind, and three leaflets (2007, 2012 and 2019) from the Royal College of Psychiatrists.

An accuracy score was devised by giving leaflets a point for any of 29 accurate statements and deducting a point for any of 11 inaccurate statements.

Firstly the authors looked at how many trust leaflets included each of the statements. At this stage the Mind and Royal College leaflets were excluded.

The most common statement to be included was “Average number of ECTs in a series stated
(about ten)”, found in 35 of the 36 leaflets. A mention of general anaesthetic was included in 34 leaflets, mention of electricity/current applied to the head/brain was included in 34 leaflets, so too was mention of a seizure/fit/convulsion. How, I wonder, did two trusts manage to write a patient information leaflet without mentioning electricity? Or perhaps they were vague about where it was applied. All the above were positive-scoring statements. As far as negative-scoring, or inaccurate, statements were concerned, the most common were “Unevidenced claims of very low mortality rates” (28 leaflets), and “Any minimization/denial of memory loss in terms of severity or prevalence…” (23 leaflets).

By combining the positive and negative scores, the authors produced a league table of leaflets. The top two places went to the two Mind leaflets, scoring 19 and 16. The authors say: “The current Mind leaflet (2019) is the only leaflet to include none of the 11 inaccurate statements.” I would take issue with the authors here as I think the Mind leaflet’s statement “The ECT machine will deliver a series of brief, high-voltage electrical pulses” qualifies as minimizing size/strength of current in so far as it refers to brief electrical pulses, as in fact machines deliver one electric shock rather than pulses, which is just a reference to the wave form of the current – a very technical detail. High-voltage incidentally, while certainly not minimising, is not a particularly useful description as the term has no commonly accepted single definition. None of the leaflets included information about electrical parameters (volts, milliamps, etc).

Leicestershire was the highest placed trust, with 15 points. At the bottom of the table was Oxleas, with minus two points. Neither trust’s leaflet is available online. However, I did find an on-line leaflet from the Cornwall Partnership (joint second to last). The introduction to the leaflet says:

During treatment, a tiny amount of electric current is sent to the brain. This affects the entire brain and repeated treatments alter the brains chemical messages bringing them back to normal.

The leaflet itself continues in similar vein. It looked familiar; my guess would be that it was cloned from an old Royal College leaflet, one that pre-dates the 2007, 2012, and 2020 Royal College leaflets cited in the audit. I searched for one particular phrase in the leaflet, about patients recovering their ability to work and “lead a productive life”. What I wonder is a productive life? Is there a rating scale? And has anyone ever counted how many people recover their ability to work after ECT? Not surprisingly, a search for the productive life phrase took me to an Oxleas magazine article, where I also found an almost identical sentence about chemical messages being brought back to normal. More surprisingly it took me to 2004/05 ECT statistics from New Zealand and a 1994 written answer in the United Kingdom Parliament. Eventually I found the original – a 1993 leaflet from the Royal College.

The authors of the audit conclude:

While there were many instances of exaggerating positive outcomes and minimizing negative outcomes, there was not a single instance of minimizing positives or exaggerating negatives. The bias was unidirectional and consistent. This implies that the inaccuracies represent systemic, institutional bias. Perhaps one motivation for this bias is a fear that if people are told the whole truth even fewer will voluntarily accept the treatment.

*Christopher Harrop, John Read, Jim Geekie, Julia Renton, “How accurate are ECT patient information leaflets provided by mental health services in England and the Royal College of Psychiatrists? An independent audit.” Ethical Human Psychology and Psychiatry, Volume 23, Number 1, 2021.

Posted in ECT in the UK, Miscellaneous | Leave a comment

ECT: another lie in Parliament

In a post in January 2021 I wrote about a misleading answer given by Nadine Dorries (Minister of State (Department of Health and Social Care).In response to a question about electroconvulsive therapy (ECT) asked by shadow minister for mental health Dr Rosena Allin-Khan, Ms Dorries said that ECT “generally can only be given when a patient consents“. The word “generally” is quite misleading in this context as about 45 per cent of ECT patients in England are treated without their consent.

On 16 June 2021 Ms Dorries answered another question about ECT, this time from Harriett Baldwin, Conservative MP for West Worcestershire. And this time she has abandoned the generally and says: “Electroconvulsive therapy is regulated under the Mental Health Act 1983 and can only be given when a patient consents“. This is an outright lie. ECT can be given both with and without consent. Nearly half of ECT patients in England do not consent to treatment.

Posted in ECT in the UK, ECT without consent | 1 Comment

ECT at Lake Alice: a team of maggots

I have written here about psychiatrist Selwyn Leeks and the use of electroconvulsive therapy (ECT) on children and young people at Lake Alice Hospital in New Zealand in the 1970s.

On Monday 14 June 2021 a Royal Commission on Abuse in Care started a two week public hearing into abuse at Lake Alice. One of the first witnesses was Tyrone Marks, who had been admitted to the unit when 11 years old. Stuff reported that Marks holds “Leeks and his staff responsible for what happened, describing them as the ‘team of maggots'”.

Posted in 1970s, ECT and memory loss, ECT and young people, ECT in the media, ECT worldwide, Legal cases | Leave a comment

Barbiturates then and now

In December 2020 I wrote a post about psychiatrist Kenneth Milner and his use of the barbiturate sodium amytal on children at Aston Hall. I was struck, in reading the police report on Aston Hall Hospital, by comments made by Professor Sir Simon Wessely about how sodium amytal was commonly used and how he remembers using it on children in the 1980s.

“Use of sodium amytal was common practice and [Wessely] remembers using it on children in the 1980s.”

It left me wondering what happened to barbiturates and to what extent they are still used.

The NHS Business Services Authority 2020 report on medicines used in mental health in England 2015/16 to 2019/20 said that there were 2,520 prescriptions in the community for barbiturates as hypnotics or anxiolytics in 2019/20, a decrease of nearly 50 per cent over a four year period. The report says:

“The low level of prescribing for barbiturates may reflect the National Institute for Health and Care Excellence (NICE)’s advice against the use of intermediate-acting barbiturates except in the treatment of severe intractable insomnia in patients already taking barbiturates. NICE also advises that use of long-acting barbiturates as a sedative is not justified.”

These figures do not include other uses of barbiturates, for example in anaesthesia or for the treatment of epilepsy. Neither do they include barbiturates dispensed in hospitals.

In 2001/02 there were 52,000 prescriptions for barbiturates in England, according to a written answer in Parliament.

In 1973/74 there were by contrast 8,348,900 prescriptions for barbiturates in England. This was nearly 15 years after the widespread introduction of benzodiazepines, which are always said to have replaced barbiturates. Minister of State Dr Owen said in a written answer in Parliament:

“Doctors who have prescribed barbiturates more heavily than their colleagues receive advice from my Department’s Regional Medical Service.”

Barbiturates had long been controversial. In the 1930s there was something referred to as “the battle of the barbiturates”, with the drugs being criticised by Home Office toxicologist Sir William Wilcox and defended by psychiatrists such as R.D. Gillespie, Maurice Craig and then William Sargant. But this did not stop their increasing use and by 1959 GPs in England were prescribing 162,000 lbs of barbiturates (representing 1620 million doses), up from 90,000 lbs in 1950. In terms of prescriptions, that represented over 14 million prescriptions or about 6.7 per cent GP prescriptions in the NHS in 1959. If you add in prescriptions for non-barbiturate sedatives and hypnotics, that figure becomes about 20 million. In 1959 there were 576 suicides and 232 accidental deaths associated with barbiturate poisoning.*

What strikes me about the figures for barbiturate use in the 1950s is that, although they don’t approach figures for the use of antidepressants today, it was nevertheless common in those days for people to be prescribed psychotropic drugs by their GPs.

As for use by psychiatrists of sodium amytal on children, the Journal of the American Academy of Child Psychiatry published an article, “Use of Sodium Amytal Interviews in Prepubertal Children: Indications, Procedure, and Clinical Utility”, in 1985, which lends support to Wessely’s recollection of using it on children in the 1980s. The authors of the article, from the University of Kansas, say in the abstract that “in certain clinical situations a properly performed sodium amytal interview is a useful tool in the diagnosis and treatment of prepubertal children.”

*The figures is this paragraph come from “The abuse of barbiturates in the United Kingdom”, by M. M. Glatt, Bulletin on Narcotics, 1962, published by the United Nations.

Posted in Drugs | 1 Comment

ECT for agression in dementia in Canada

I used to have a postcard from Oxfam which said something along the lines of “I don’t know whether to be a shining example or a dreadful warning” and I am sometimes reminded of these words when reading “case reports” about people given electroconvulsive therapy (ECT).

The latest example comes from researchers at Toronto University in Canada and was published in BMJ Case reports in 2018: “Efficacy and safety of maintenance electroconvulsive therapy for sustaining resolution of severe aggression in a major neurocognitive disorder”.* Should we be reassured by the thought that there are “safe and effective” treatments out there or should we be… well… worried?

This case report is about a 64-year-old deaf man with dementia who was “admitted for acute behavioural disturbances and physical aggression.” During his stay in a “geriatric mental health inpatient unit” he was given two courses of 15 and nine ECT treatments (bilateral, mostly on maximum power of 576 mC) and maintenance ECT at weekly to monthly intervals. The monthly maintenance ECT treatments were continued after he was discharged back to a long-term care facility. The following drugs were also tried (not all at once): Quetiapine XR, Clonazepam, Haloperidol, Lorazepam, Olanzapine, Risperidone, Sertraline, Trazodone, Lurasidone, Loxapine, Melatonin, Quetiapine, Medroxyprogesterone.

The authors conclude: “The current case report supports employment of alternating acute and maintenance ECT trials to treat patients with MND [major neurocognitive disorder] with severe and refractory BPSD [behavioural and psychological symptoms of dementia].”

* Selvadurai MI, Waxman R, Ghaffar O, et al Efficacy and safety of maintenance electroconvulsive therapy for sustaining resolution of severe aggression in a major neurocognitive disorderCase Reports 2018; 2018:bcr-2017-222100.

Posted in ECT worldwide, Electrical parameters | 1 Comment

ECT: an exciting and rare opportunity

Hywel Dda University Health Board are advertising for a nurse to join their electroconvulsive therapy (ECT) team.

An exciting and rare opportunity has arisen for a Band 5 Electroconvulsive Therapy Recovery (ECT) Nurse to join the ECT Team for Hywel Dda University Health Board. This is a part time permenant post, working 15 hours per week on Monday and Thursdays.

We are looking for a highly motivated ECT Recovery Nurse to deliver safe, person centered and quality care and treatment. The department provides ECT treatment and support to both inpatients and out patients suffering from mental health illness. Your role will be to assist the Lead ECT Nurse in the running and management of the ECT clinic and provide recovery care for patients having ECT.

Someone in 2019 put in a Freedom of Information request about the use of ECT by Hywel Dda Health Board. The latest full year for which figures are available was 2018, when 34 people underwent 462 treatments. Half of the patients did not consent to treatment.

With ECT given on two days a week, that works out to an average of about four patients every session. The job of recovery nurse allows 7.5 hours for the treatment of those four patients which seems quite generous but then there are presumably some administrative tasks to do. The job description talks about “facilitating a seamless patient pathway throughout the ECT delivery” and “Extremely challenging / hostile patient group with complex needs.” Perhaps the latter refers to non-consenting patients, or perhaps it has just been cut-and-pasted from another job description.

Posted in ECT in the UK, ECT without consent | 1 Comment