Central and North West London (CNWL) NHS Foundation Trust produce a patient information leaflet on electroconvulsive therapy (ECT) which makes the astonishing claim that the “risk of any problems” is one in 50,000 treatments.
“ECT is amongst the safest medical treatments given under general anaesthesia. The risk of any problems is one in 50,000 treatments which is much lower than childbirth for instance”.
The CNWL Trust leaflet is based on one published by the Royal College of Psychiatrists in 1995 and now withdrawn by them, although it lives on in several mental health trusts. The 1 in 50,000 statistic is anyway repeated in the current Royal College leaflet on ECT. The Royal College version however referred to the risk of “death or serious injury” which the CNWL Trust have changed to “any problems“. I wonder what they mean by a “problem“? And where does the statistic actually come from?
The 1 in 50,000 statistic originated in California circa 1980 and it is a death statistic, not one for serious injury (wouldn’t complication be a better term?), and certainly not for problems. Psychiatrists in California are required to report only those deaths which occur within 24 hours of treatment, which accounts for the low rate – and more recent Californian statistics show an even lower rate. As for problems, psychiatrists in California are also required to report: cardiac arrests, fractures, apnea lasting more than 20 minutes, and memory loss lasting more than 3 months. Between 1989 and 1994, for example, there were no deaths within 24 hours, but approximately 1 in 2,500 people suffered cardiac arrest, a similar number suffered fractures, 1 in 5 had memory loss lasting more than 3 months and 1 in 80 experienced prolonged apnea.
Meanwhile, in the England and Wales, there have been no attempts to collect information on the number of deaths following ECT. No-one knows how many people undergo ECT, let alone how many die within a certain time of ECT, or suffer cardiac arrest, memory loss, etc. The Mental Health Act Commission, however, in their final report, noted that 39 detained patients had died within a week of ECT over a period of 4 years.
In Scotland slightly more information is available. In 2008 there were 13 reports of “critical incidents”, a rate of about 1 in 250 treatments, and in 2009 about one in 50 courses were stopped prematurely because of side-effects. These figures indicate a rate of “problems” much higher than the 1 in 50,000 treatments claimed by the CNWL Trust leaflet.
The CNWL Trust leaflet says: “You may wish to know why ECT is used, what ECT is, what it is like to have ECT and what the risks and beneﬁts may be”. Hasn’t it occurred to them, that some-one undergoing ECT in London in 2010 may wish to be given some more relevant information about risks than an adulterated death statistic from California circa 1980? And what has it got to do with childbirth?