ECT without consent: the gender imbalance

In their thirteenth – and final – biennial report, the MHAC touched on the subject of gender imbalance and electroconvulsive therapy (ECT).

In 2007/2008 just over half the requests to use ECT under section 58 of the Mental Health Act (that is, on patients who are not consenting to treatment) were for patients over the age of 65. Women accounted for almost three-quarters (76 per cent) of these patients. “This is likely to reflect differences in longevity between men and women” says the MHAC. Is it?

In fact, according to the Office for National Statistics, there are 129 women for every 100 men aged 65 or over in the UK, which would account for a 56/44 split, but not a 76/24 one.

The MHAC do, however, acknowledge that women outnumber men in the younger age groups as well (with the exception of the 25-34 age group where they are nearly equal) and go on to say:

“The differing proportions of men and women referred for ECT may also reflect objective differences between the sexes in clinical presentation, relating to the nature or degree of illness being treated. But we do not rule out the possible influence of gender stereotypes, and suggest that these differences would be a suitable subject for further research.”

Women, in 2005/2007, made up only about one in five of the second opinion appointed doctors (the psychiatrists on the Mental Health Act Commission panel who authorize treatment without consent).

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