Section 58A of the Mental Health Act 2007 provides for the use of electroconvulsive therapy (ECT) on non-consenting incapable patients with the approval of a second opinion appointed doctor (SOAD), who is a psychiatrist from the Care Quality Commission’s panel. However there are circumstances in which patients can be given ECT without either their consent or a second opinion. If an informal patient is incapable of consenting to treatment but is not objecting to it, they may be treated under common law. No statistics are collected on how many people are treated with ECT in this way, but the number is thought to be very small and some psychiatrists don’t seem to be aware of this option. The other way in which someone can be given ECT without consent or a second opinion is under section 62 of the Mental Health Act, which allows a psychiatrist to give someone ECT before obtaining a SOAD’s permission if they think that the person needs ECT urgently.
According to the report of the Care Quality Commission (CQC) on the administration of the Mental Health Act 2009/10, a record proportion of patients had already been given ECT under section 62 prior to a SOAD visit. This the CQC found “a matter of concern”.
The numbers of people treated under section 62 prior to a SOAD visit in recent years are as follows:
2004/05 432 33% of all SOAD visits
2005/06 499 18%
2006/07 415 21%
2007/08 357 23%
2008/09 296 26%
2009/10 445 24%
There may also, as the last biennial report of the Mental Health Act Commission pointed out, be some people who are given ECT under section 62 without a subsequent SOAD visit and who won’t therefore be included in the statistics.
The CQC admits that the increase may be partly due to delays in providing a SOAD. On average it took 6 days to arrange a visit. The problem has arisen because of the number of requests not for ECT visits, which have declined slightly, but for visits to approve medication (which are necessary after a patient has been detained for 3 months), and for visits for community treatment orders, which are much being used at a much greater rate than the government predicted. Altogether in 2009/10 there were over 15,000 requests for SOAD visits and only about 100 SOADs to do them. Fifteen years ago there were about 150 SOADs and only about 5,400 requests for visits. SOAD appointments are not for a full-time or even a part-time position; SOADs carry out visits for the CQC for a fee in addition to their regular work.
If the CQC could halve the time it took to arrange a SOAD visit, there would be little excuse for psychiatrists to use section 62. Patients who are thought to need ECT urgently are generally treated at the regular twice-weekly ECT clinics. If treatment is expected to wait 3-4 days for the next clinic, then it should be able to wait a similar length of time for a SOAD visit.