Electroconvulsive therapy in Birmingham

During the last year, according to an article in the Birmingham Mail, 51 people underwent electro convulsive therapy (ECT) in Birmingham and Solihull. Twenty-two of them were detained patients.

ECT in Birmingham is given at the Oleaster centre, one of the new units named after shrubs which replaced the Queen Elizabeth Psychiatric Hospital. Birmingham has in the past been a heavy user of ECT. An article by Peter Bentham in the Journal of Clinical Governance in the 1990s remarked on the high use of ECT in Birmingham.  The website of the Birmingham and Solihull Mental Health NHS Foundation Trust (BSMHFT) website says they have a catchment population of 1.2 million, so this figure of 51 would suggest that their use of ECT is no longer particularly high.

I searched the BSMHFT website to see if they had any information about ECT. The search came up with one match but didn’t tell me what it was. I looked in one or two likely places but couldn’t find anything. The leaflet entitled “Inpatient and outpatient services and your care” makes no mention of ECT although it contains a long list of questions to ask about medication. A brief page on depression says it is one of the most easily treated mental health problems but doesn’t say what with.

Older statistics from the Department of Health on ECT use in the Birmingham area show that there has been a major reduction in the past 21 years. Statistics for the year ending March 1991 showed approximately 600 people undergoing the treatment. It is impossible to say exactly how many, as the statistics count individual treatments – 3,880 in Birmingham and Solihull – not courses, but with an average of 6 to 7 treatments in a course that gives something in the region of 600 courses and slightly fewer people as some people undergo more than one course in a year. So there has been a reduction of about 90 per cent in ECT use in Birmingham over the past two decades.

Detained patients accounted for more than 40 per cent of those treated with ECT in the Birmingham and Solihull area last year. The Birmingham Mail article didn’t say how many of these patients consented to treatment, but the majority of detained patients who receive ECT are treated without their consent. In 2008/09 Birmingham and Solihull Mental Health NHS Trust made 50 requests for a psychiatrist from the Care Quality Commission to authorise ECT for detained, non-consenting patients which would suggest a higher use of ECT on detained patients at that time than last year. Over England as a whole a survey published in The Psychiatrist found that in 2006 thirty per cent of ECT patients were detained. The actual numbers of detained patients undergoing ECT have remained relatively stable since the introduction of the Mental Health Act 1983 – they form an increasing proportion of those treated with ECT as the numbers of consenting patients decline.

The situation in which a psychiatrist and patient agree on ECT is becoming increasingly rare. At the moment detained patients, most of whom are non-consenting, are still in the minority. Will they soon be in the majority? Will ECT eventually become a treatment that is only given to people who can’t say no – or yes? Trends can always be reversed, but at the moment it looks as if this is at least a possibility. And yet it is something that has attracted very little attention from psychiatrists – the rising proportion of detained patients receiving ECT is simply noted, but explanations are not sought nor implications considered.

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