ECT in New Zealand: are the statistics reliable?

Earlier this month (10 October 2011) the Office of the Director of Mental Health in New Zealand published their annual report for 2010. The report contains statistics on the use of electroconvulsive therapy ECT in New Zealand from July 2009 to June 2010.

According to the report a total of 235 people received ECT in New Zealand (5.4 per 100,000 population) over the year. Compared to Australia, with which it shares a professional body (The Royal Australian and New Zealand Royal College of Psychiatrists), New Zealand has a much lower rate of ECT use. The population of New Zealand is approaching four and a half million. Victoria in Australia has a population of approaching five and a half million and yet over a similar time period gave ECT to about 1750 people, which is about six times the rate of use as New Zealand. Another difference is that there appears to be no ECT given in private psychiatric facilities in New Zealand, at least according to a survey published in 2005.

Over a quarter of ECT patients in New Zealand did not consent to treatment according to the annual report. Mental health legislation allows for ECT without consent with the approval of a psychiatrist from the Mental Health Review Tribunal on both patients deemed to lack capacity to make a decision and those with capacity who don’t want ECT. The report (and several previous reports) say that in fact only those “not able to consent” are treated without consent and that people who are able to make decisions are never given ECT against their wishes. However a case a few years ago where someone who was being given ECT without consent walked into a TV station to complain about their treatment raises questions about exactly what “unable to consent” means. The psychiatrist who was treating them complained about the TV programme and the case went to the High Court which found in favour of the TV company.  The proportion of patients treated without their consent varies across the District Health Boards (DHBs). In the Canterbury DHB only one (out of 31) patient was reported as non-consenting, in Waitemata it was 16 patients (out of 45).

Over half of ECT patients in New Zealand are over 55 years of age; 73 per cent are women (the usual excuses are given: “more women present to mental health services with depressive disorders”, “the ratio is similar to that reported in other countries”).

The report gives the numbers of people treated in each DHB (District Health Board). There are wide variations, with Otago and Waikato using ECT at about twice or more the average rate (although they may be treating some patients from other areas). Otago was once served by Seacliff Asylum, where writer Janet Frame underwent ECT.

Are these published figures reliable? I have my doubts. The report says in the small print accompanying a table that the figures for 6 DHBs come from PRIMHD (Programme for the Integration of Mental Health Data – an electronic system). And then they say that 4 of these DHBs made changes to their ECT data “that are not reflected in this report”. In the case of Canterbury DHB it was a major change – from 31 patients to 54.  And an even bigger problem appears when the report calculates the average number of treatments per course and comes up with an improbably low national average of 3.62. The 235 people, even when those having ECT at the beginning or end of the year and those having only maintenance ECT were removed, had 412 courses of ECT according to the report. Although some people do have more than one course of ECT in a year it seems improbable that so many people could have had multiple courses of ECT.

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