WLMHT ECT leaflet

While I was looking for examples of psychiatrists who refer to the current used in electroconvulsive therapy (ECT) as small, in spite of the fact that it is actually in the region of 750-900 mA, I came across this publication from the West London Mental Health Trust (WLMHT). The WLMHT is based at the St Bernard’s Hospital site in Ealing (what used to be Hanwell Asylum).

The leaflet starts off by describing ECT as a treatment for schizophrenia:

“In spite of having had a bad press in the past, electroconvulsive therapy (ECT) can be very effective at relieving symptoms for people with strong and persistent negative symptoms of schizophrenia. Some people with schizophrenia are determined to take their own lives, and in such situations the treatment can have a very rapid and positive effect”.

A small percentage of ECT patients in England (about 7 per cent in 2002) do have a diagnosis of schizophrenia, but in the UK ECT is most commonly used in the treatment of depression. And even when ECT was used more widely for the treatment of schizophrenia it was thought to be useful in treating positive, rather than negative symptoms.

The next bit of the leaflet is taken from the Royal College of Psychiatrists’ leaflet on ECT and the Care Quality Commission’s leaflet on consent to treatment. At least it is reasonable for a hospital in England to use publications from the Royal College of Psychiatrists or the Care Quality Commission as a template for their patient information publications. It is the second half of the leaflet that is the real problem.

Electroconvulsive therapy is usually given three times a week“. In England ECT is usually given twice a week. Perhaps WLMHT is unusual and actually does give people ECT 3 times a week.

Up to half of those having electroconvulsive therapy experience a relapse within six months. Consequently, the WLMHT care team may also prescribe antidepressants, lithium or further electroconvulsive therapy at monthly or six-weekly intervals“.

Maintenance or continuation ECT is used by a few psychiatrists in England – perhaps it is used at WLMHT. But the problem with all this is that it was taken from this website and comes from a book by Demitri Papolos published in the 1980s in the United States, where ECT is usually given 3 times a week and maintenance or continuation ECT is more common. Different countries have different practices when it comes to ECT, and what happens in America isn’t necessarily what happens in the United Kingdom.

WLMHT is audited and has been commended for the quality of its ECT treatment“, they tell us twice, but I wonder if the auditors looked at the information leaflet?

At least the leaflet isn’t illustrated with a picture of American models. Instead there is a picture of a machine, but I am not sure that it is an ECT machine. It appears to have an air pressure gauge (perhaps ECT machines do have air pressure gauges – I don’t know).

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3 Responses to WLMHT ECT leaflet

  1. Cheryl Prax says:

    Interesting that WLMHT say “WLMHT is audited and has been commended for the quality of its ECT treatment“, as according to ECTAS (28 October 2010) only their John Conolly wing, Southall has been accredited. Broadmoor Berkshire is in review (cycle 2). Not that this means anything anyway as ECTAS is the psychiatrist’s self governing body for ECT. They are not likely to whistleblow! In my trust CNWL they only have one out of four accredited. Under a freedom of information request CNWL told me that a small proportion complained of short term memory loss which they mainly regained, however looking at the ECTAS report for Riverside clinic where (only) seven patients were questioned, three said they had mild/temporary memory loss and two said they severe/long term memory loss. One or two patients answered most of the other questions with ‘I don’t remember’! CNWL’s ECT leaflet extolls ECT as a treatment.

    • Thank you for your comment. I have just looked at the CNWL leaflet. It is based on the Royal College of Psychiatrists 1993 leaflet. This was withdrawn a while ago, and the current one does at least acknowledge the possibility of persistent memory loss, although with all the usual qualifications and attempts to discredit patients (complain, not clear, etc):
      “Some difficulties with memory are probably present in everyone receiving ECT. Most people find these memories return when the course of ECT has finished and a few weeks have passed. However, some people do complain that their memory has been permanently affected, that their memories never come back. It is not clear how much of this is due to the ECT and how much is due to the depressive illness or other factors. ”
      As for CNWL’s claim that “the risk of any problems is one in 50,000”: that was originally a death statistic from California, where there is a requirement to report deaths that occurred within 24 hours (I think) of ECT. The Royal College of Psychiatrists added “serious injury” to that and now CNWL turns it into “any problem”. Not quite the same thing (unless it is one of those medical conventions like talking about people as being “comfortable”). The bit about “leading a productive life again” (also from the old Royal College leaflet) sounds very 1950s and anyway, who is counting?

      • Cheryl Prax says:

        Thanks for that!
        Another weapon in the fight against CNWL and their blinkered opinions.
        CNWL have copied the one in 50,000 statistic from Somatics the manufacturer of the Thymatron ECT machines which they use.

        http://www.thymatron.com/main_faq.asp

        The denial of brain damage should be a case for liable.
        See also their downloadable brochure.

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