ECT without consent in Wales

Eighty per cent of the people given electroconvulsive therapy (ECT) without their consent in Wales last year were women. This fact is revealed by detailed statistics recently published by the Health Inspectorate Wales (HIW).

Between April 2010 and March 2011 there were 79 requests for a second opinion appointed doctor (SOAD) from the HIW to authorise the use of ECT on patients lacking capacity to consent to the treatment. Four requests were cancelled, in 5 cases it was decided that the patient was consenting,  and six cases were refused leaving 64 occasions on which the use of ECT without consent was authorised. And on 51 on these occasions the patient was a woman.

Cardiff and Vale University Health Board (catchment population 450,000) was the highest user of ECT on non-consenting patients, although it is not the largest health board in Wales. And 90 per cent of the patients were women. Hywel Dda Health Board (catchment population 372,000) was the second highest user (80 per cent women).  At the other end of the scale Cwm Taf Local Health Board (catchment population 325,000) made only 2 requests and both were for men.

Women are of course usually over-represented in surveys of ECT use in Western Europe, Scandinavia, Northern America and Australasia (in the rest of the world the sexes are more evenly balanced). Psychiatrists have never been concerned about this and say that it is due to the fact that women are more likely to be depressed than men – true, but not to quite the same extent they appear in the ECT statistics.

On the other side of the electrodes, ECT is a predominately male business. Invented by men, it is still largely men who decide how ECT should be used; men who write the text books on ECT and make up the committees which produce the guidelines. A survey of ECT use some years ago in the United States found that all else being equal, male psychiatrists were much more likely to use ECT than female psychiatrists. It would be interesting to see the results if such a survey was repeated at the present time and in other countries. Amongst the big names in ECT there are very few women: Sarah Lisanby in the United States and Colleen Loo in Australia are about the only two I can think of.

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