Latest ECT statistics from Australia

Since my last post, about the use of electroconvulsive therapy (ECT) in Australia, the chief psychiatrist’s annual report for 2009-10 has appeared on the website of the Victorian Department of Health. The statistics for ECT are very similar to those in the 2008-9 report: there is a small increase in the number of treatments and a small decrease in the number of patients. The report says the increase in the average number of treatments per person is due to an increase in the use of maintenance treatment (although they don’t say how many people were receiving maintenance ECT). The number of treatments given to men in their forties have increased by about fifty per cent. Young people under the age of 18 received 83 treatments – up from 46 in 2008-9, although the number of under 18 year olds treated remained the same (seven in both years). Surely they cannot be using maintenance ECT on this age group? This statistic was reported incorrectly in The Age as: “A total of 1750 patients received electroconvulsive therapy (ECT), including 83 children, the youngest of whom was 13.” It was seven children and 83 treatments, not 83 children. The youngest was indeed 13. Perhaps surprisingly, since ECT is usually talked about as a treatment for depression – at least in Western countries, about one in five of the treatments were being given to people with a diagnosis of “schizophrenia, schizotypal or delusional disorders”.

ECT appears to be used at about twice the rate in Victoria as in neighbouring New South Wales (at least in public hospitals) but, according to this article in the The Sydney Morning Herald, New South Wales is using more ECT on the under 24s.  In New Zealand, which  shares a professional psychiatric body – The Royal Australian and New Zealand College of Psychiatrists (RANZCP) – with Australia, the use of ECT is lower still. The most recent figures date from five years ago, but show 307 people receiving an average of 7 treatments each. That means Victoria is using ECT at more than four times the rate of New Zealand. Which, if either, is right? Is it used too much in Victoria or too little in New Zealand? Such questions are never tackled. As the authors of a paper called “Epidemiological analysis of electroconvulsive therapy in Victoria, Australia” and published in the Australian and New Zealand Journal of Psychiatry in 2003 pointed out: “Despite decades of use, the appropriate rate of ECT utilization is still unclear”.

The recent articles about ECT in The Sydney Morning Herald inspired this letter from a reader:

“I was, through an involuntary court order, forced to undergo multiple courses of electroconvulsive therapy in 2008. I am concerned that recent articles (”Controversy hasn’t killed off electric shock therapy”, May 30; ”ECT patients under anaesthetic for two days”, June 18; ”Electric shock therapy on the rise for young”, June 26) overstate the efficacy of this form of treatment and understate its potential for serious side effects. Current research shows the effectiveness of ”modern” ECT is far below the 80 per cent quoted, and even when it is effective, relapse rates within six months are extremely high. ECT was initially ”effective” for me, but my improvement would not even last three days. So I was shocked again and again. I have suffered severe, persistent and disabling side effects, including a profound loss of memory affecting more than 10 years before the ECT. I am unable to return to my legal career, having forgotten my previous jobs and much of my legal education. I no longer recognise many close friends. The risk of serious side effects is well-known, but patients are seldom informed about them. We need more honesty from those providing ECT, and better research from journalists reporting it.” Mariana Oppermann, Lyons (ACT)

It is a reminder that, in spite of claims from psychiatrists that ECT has changed in recent years, the risk of memory loss remains. One of the “new” techniques being promoted by psychiatrists in Australia at the moment is ultra-brief pulse ECT, which involves a slight modification to the wave form of the current used in ECT and isn’t new at all, having been first used in the 1940s. This is what the Victoria chief psychiatrist’s report has to say about it. 

“Ultra brief pulse ECT is increasingly being used in the private sector and its proponents believe it has potential to minimise possible side-effects of ECT, such as temporary memory loss. This model of providing ECT was discussed by the ECT sub-committee of the QAC in 2009-10. The majority view was that the model has not yet been adequately evaluated and needs a stronger evidence base before it can be accepted more widely”.

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3 Responses to Latest ECT statistics from Australia

  1. Mariana Oppermann says:

    ECT statistics in the Australian Capital Territory: media response

    Hi, I live in Canberra and three years ago was subject to a long series of in voluntary ECT sessions with devastating results.

    Thank you for posting a copy of my letter to the Sydney Morning Herald on your website-it is good to know that there are people reading it. If anyone in Canberra or beyond would like to contact me my e-mail address is mariana.oppermann@hotmail.com

    The Canberra Times recently ran an article “electric therapy numbers revealed” (2 August 2011).
    Available at: http://www.canberratimes.com.au/news/local/news/general/electric-therapy-numbers-revealed/2245069.aspx#

    I wrote a letter to the Canberra Times, which was published on the 12th August. It states:

    Dear Editor,
    I am one of the statistics quoted in your article on electroconvulsive therapy (2 August).
    I was, through involuntary court orders, forced to undergo multiple courses of electroconvulsive therapy (ECT) in 2008. ECT was initially “effective” for me, but my improvement would not even last three days. So I was shocked again and again.
    I have suffered severe, persistent and disabling side-effects, including a profound loss of memory spanning a period of over 10 years prior to ECT. I am unable to return to my legal career, having forgotten many previous jobs and much of my legal education. I no longer recognise many close friends. The risk of serious side effects is well-known, but patients are seldom informed about them.
    The written information provided to me by the hospital misrepresented the evidence basis; overstating effectiveness, failing to disclose the overwhelmingly short duration of any improvement, and misrepresenting the risks involved, particularly those related to memory loss.
    Evidence-based treatment requires an honest , inclusive and transparent appraisal of research, accurate disclosure of information to patients, and that adverse effects experienced by patients be taken seriously.
    Perhaps then, patients and tribunals (and doctors) will be able to make truly informed decisions, and the voice of those who, like me, have had their lives devastated by ECT will be reflected in the ‘evidence’ we chose to report.

    Mariana Oppermann

  2. Mariana Oppermann says:

    ECT statistics in the Australian Capital Territory: government response

    Recently a Green member of the Legislative Assembly (Amanda Bresnan) asked a series of questions on notice regarding the provision of ECT in the ACT.

    The government response was provided on 5 May 2011 and can be found in the Legislative Assembly for the ACT: 2011 Week 5 Hansard (5 May) starting at Page 1983.

    (Available at: http://www.hansard.act.gov.au/hansard/2011/links/download.htm)

    (Hi Moderator- I’ve “cut and pasted” the relevant bit of Hansard, but if all the formatting is lost feel free to remove it. Thank you for hosting this excellent site 🙂

    Hansard 5 May 2011 – evidence for continued use ECT and 2006-11 Stats

    Legislative Assembly for the ACT: 2011 Week 5 Hansard (5 May) . . Page.. 1983..
    Mental health—electroconvulsive therapy (Question No 1585)
    Ms Bresnan asked the Minister for Health, upon notice, on 9 March 2011:
    (1) What is the evidence that the ACT Government draws on to support the use of electroconvulsive therapy on some consumers, given that clause 3 of the Draft Charter of Rights for Mental Health Consumers states that consumers have the right to evidence based health care at all stages of their illness.
    (2) How many people have received electroconvulsive therapy under a electroconvulsive therapy order, pursuant to section 55E of the Mental Health (Treatment and Care) Act 1994, in (a) 2006, (b) 2007, (c) 2008, (d) 2009, (e) 2010 and (f) 2011 to date.
    (3) On how many occasions has electroconvulsive therapy, under an electroconvulsive therapy order, been conducted in (a) 2006, (b) 2007, (c) 2008, (d) 2009, (e) 2010 and (f) 2011 to date.
    (4) How many people have received electroconvulsive therapy, that was given with the consumers consent and not because of an electroconvulsive therapy order, in (a) 2006, (b) 2007, (c) 2008, (d) 2009, (e) 2010 and (f) 2011 to date.
    (5) On how many occasions has electroconvulsive therapy been conducted, that was given with the consumers consent and not because of an electroconvulsive therapy order in (a) 2006, (b) 2007, (c) 2008, (d) 2009, (e) 2010 and (f) 2011 to date.
    (6) How many consumers received electroconvulsive therapy on 10 or more occasions (a) under and (b) not under an electroconvulsive therapy order for the period covering 2006 to date.

    Legislative Assembly for the ACT: 2011 Week 5 Hansard (5 May) . . Page.. 1984..
    (7) What is the most number of occasions that any singular person has received electroconvulsive therapy between 2006 to date.
    Ms Gallagher: I am advised that the answer to the member’s question is as follows:
    (1) Electroconvulsive Therapy (ECT) was introduced into psychiatric practice in 1934. It was initially hailed as a treatment for Schizophrenia, and quickly recognised as an effective treatment for the affective disorders. The use of ECT is supported by the American Psychiatric Association for Major depression, Mania and Schizophrenia and the Royal Australian and New Zealand College of Psychiatrists gives similar support. ECT has been extensively researched and its effectiveness has been supported by reviews and meta analyses covering the last 20 years.
    (2) The number of people who received electroconvulsive therapy under a electroconvulsive therapy order, pursuant to section 55E of the Mental Health (Treatment and Care) Act 1994 are:
    2006-2007 – 25 people 2007-2008 – 17 people 2008-2009 – 15 people 2009-2010 – 11 people 2010-2011 – 6 people to date
    These figures do not include Emergency ECT orders.
    (3) The number of occasions that electroconvulsive therapy has been conducted under an electroconvulsive therapy order is:
    (a) July 2006 – June 2007 Data not available. (b) July 2007 – June 2008 Data not available. (c) July 2008 – June 2009 160 (d) July 2009 – June 2010 142 (e) July 2010 – June 2011 38
    (4) The number of people who have received electroconvulsive therapy, that was given with the consumer’s consent and not because of an electroconvulsive therapy order, is:
    (a) July 2006 – June 2007 Data not available. (b) July 2007 – June 2008 Data not available. (c) July 2008 – June 2009 208 (d) July 2009 – June 2010 121 (e) July 2010 – June 2011 148
    (5) The number of occasions that electroconvulsive therapy has been conducted, and given with the consumer’s consent and not because of an electroconvulsive therapy order, is:
    (a) July 2006 – June 2007 Data not available. (b) July 2007 – June 2008 Data not available. (c) July 2008 – June 2009 17 (d) July 2009 – June 2010 12 (e) July 2010 – June 2011 12

    Legislative Assembly for the ACT: 2011 Week 5 Hansard (5 May) . . Page.. 1985..
    (6) The number of consumers who received electroconvulsive therapy on 10 or more occasions (a) under and (b) not under an electroconvulsive therapy order for the period covering 2006 to date is a cumulative total of:
    (a) More than 10 Involuntary 18 (b) More than 10 Voluntary 27
    (7) The most number of occasions that any singular person has received electroconvulsive therapy between 2006 to date is a cumulative total of 138 voluntary treatments.

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