The 1 July edition of the Australian newspaper The Age has an article about the annual report (2009-2010) of the chief psychiatrist of Victoria. After discussing deaths of psychiatric patients and the use of seclusion, the article has this to say about the use of ECT in Victoria:
A total of 1750 patients received electroconvulsive therapy (ECT), including 83 children, the youngest of whom was 13. Psychiatrists consented to the procedure on behalf of a third of public patients, which Dr Vine said reflected the severity of their illness. Mental Health Minister Mary Wooldridge has said she is reconsidering reforms to Victoria’s mental health laws, including requiring a tribunal to approve ECT for involuntary patients. Victoria is the only jurisdiction in Australia that allows ECT to be given without consent or an external review. But Dr Vine said: ”Compared with other states Victoria has the most regulated ECT in terms of places being licensed and machinery and personnel being proscribed.”
Victoria has a population of very approximately five and half million. So 1750 patients a year gives them a high rate of ECT for a Western country – more than twice the rate in England, more than 3 times the rate in Scotland, and nearly 4 times the rate in Texas.
The most recent annual report that is available on the website of the Victorian Department of Health is for 2008-9. That year, 1791 patients received a total of 19,558 treatments. That means that the average number of treatments per patient is much higher in Victoria than in the UK. 38 per cent of treatments were provided by private hospitals, up from 28 per cent in 2003-4. Between 2003-4 and 2008-9 the number of treatments rose by about 25 per cent, but the number of patients by only about 10 per cent. Courses of treatment are getting longer, and/or more patients are having maintenance ECT.
A breakdown of the 2008-9 figures for individual treatments (not patients) by age showed 203 treatments given to patients under the age of 20. People over the age of 60 accounted for about 35 per cent of treatments, which is a lower percentage than, for example, in the UK. 36 per cent of treatments in public hospitals were given without a patient’s consent (treatment without consent is not allowed in private hospitals). Women received 67 per cent of treatments (by contrast, the New South Wales Department of Health guidelines and policy statement on ECT were written by 15 men and one woman).
What about the rest of Australia? Last week the Sydney Morning Herald ran a story under the headline ‘Electric shock therapy on the rise for young’ which came up with some figures:
The Medicare figures show that last year, NSW men aged under 24 were given the therapy at three times the rate of men in that age group in Victoria. Across Australia, 24,714 ECT sessions were administered to patients of all ages. In NSW, 5733 treatments were carried out – slightly fewer than in Victoria.
I don’t know exactly what Medicare covers, but these figures seem, as far as Victoria is concerned, to be showing only about one third of the total ECT used. A survey of ECT use in Western Australia about a decade ago found a lower rate of use than in Victoria; the authors commented on the lack of reliable figures for ECT both in Western Australia and in the country as a whole.