The Care Quality Commission and the disappearing ECT statistics

There was a time when the Department of Health in England collected and published annual statistics on the use of electroconvulsive therapy (ECT). But for the past twenty years there have, except for two 3-month surveys in 1999 and 2002, been no reliable statistics on the use of ECT on consenting patients (who make up the majority of those given ECT). Only information about its use on non-consenting patients has been available. It was published by the Mental Health Act Commission (MHAC), the body that between 1983 and 2009 oversaw the operation of the Mental Health Act in England and Wales and was subsumed into the Care Quality Commission (in England) and the Health Inspectorate Wales (in Wales) in 2009.

During its lifetime the MHAC published thirteen biennial reports, each one containing statistics about the use of ECT on detained, non-consenting patients. The Mental Health Act 1983 had set out procedures for psychiatrists to follow when they wanted to give ECT to someone who wasn’t consenting, either because they were lacking the capacity to make a decision (incapable in the language used by the MHAC) or because they were saying no to ECT (capable but refusing). That at least was the situation until a few years ago when people who were considered to retain capacity were no longer included in section 58 – the section that allows psychiatrists to use ECT without consent as long as they have the approval of a psychiatrist from the MHAC panel. What the MHAC counted and published were statistics on the number of people receiving ECT under section 58. This didn’t include everyone treated without their consent, because psychiatrists could also treat people under emergency provisions (section 62) or the common law. On the other hand, the statistics slightly overestimated the number of people actually receiving ECT under section 58, as a small number of people did not have their treatment approved or may have had it approved but not actually gone ahead with it (for example if they suddenly got better).

According to the second biennial report of the MHAC, there were 3362 requests to use ECT on non-consenting patients in England and Wales during the two-year period July 1985-June 1987. In the third biennial report (1987-89) that figure had gone up to 4454 and remained fairly constant for a number of years. At that time it represented about 15 per cent of all ECT patients, but as the use of ECT on consenting patients decreased the percentage of non-consenting patients crept up. By the time of the 2002 Department of Health survey into ECT use more than 20 per cent of ECT courses were given to people who hadn’t consented.

The MHAC biennial reports varied in the amount of detail they gave about the use of ECT under section 58. The early reports gave just numbers; it was only with the fourth biennial report (1989-91) that information on the sex of patients undergoing ECT without consent was given – 71 per cent were women. The seventh biennial report (1995-97) was a statistical low point, giving only an approximate number. The eighth (1997-99) for the first time gave some information about the age of patients – nearly half of those being given ECT without their consent were aged over 65, while at the other end of the age range 16 young people under the age of 18 had been given ECT without their consent over the two-year period. The ninth biennial report (1999-2001) went back to giving just a number, the tenth (2001-03) had little more in the way of statistics about ECT use. The eleventh (2003-05) included some information on gender and whether ECT patients were considered “incapable” or “refusing” – over half of the women treated without consent were having their wishes over-ridden. The twelfth (2005-07) had information about the age of patients, while the thirteenth and final report (2007-09) went into greater detail than any previous report about gender (still nearly 70 per cent women) and age.

In 2009 the Care Quality Commission took over the functions of the Mental Health Act Commission. They started off well as far as ECT statistics were concerned, with their first Mental Health Act annual report (2009-10) containing four pages about ECT complete with four statistical charts: Second opinion requests for ECT, detained and CTO patients 2004/05 to 2009/10; Second opinion requests for ECT, detained patients, by age and gender, 1 April 2009 to 31 March 2010; Use of urgent treatment powers prior to second opinion visits for ECT 2004/05 to 2009/10; Outcome of second opinion visits for ECT only, 2009/10. Overall, it contained rather more statistical information on the use of ECT under the Mental Health Act than the MHAC was in the habit of publishing.

But then comes the Care Quality Commission’s second annual report, covering the period April 2010 to March 2011, and there are no statistics at all about the use of ECT. In fact, there is no mention at all of ECT. There is something about biscuit choice, but nothing at all about the over one thousand people who were given, with the approval of the Care Quality Commission, ECT without their consent during 2010-11.

In Wales, the first annual Mental Health Act monitoring report of the Health Inspectorate Wales, covering the period April 2009 to March 2010, gave only the briefest details of the number of requests to use ECT under the Mental Health Act and how many were answered within their 2 working day timescale. And, although it is now nearly 14 months since the end of the 2010-11 reporting period, a second annual report is yet to appear.

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