Earlier this month the Royal College of Psychiatrists was advertising for someone to fill the post of Deputy Programme Manager – MSNAP/ECTAS (the Memory Services National Accreditation Programme and the Electroconvulsive Therapy Accreditation Service). At first I thought that the College must have set up a programme for people who have suffered memory loss due to ECT, but no – it turns out MSNAP is entirely separate. So the post holder will be managing one programme that is about providing services for people with memory loss and another programme that is about providing a treatment which causes memory loss – a rather strange job combination.

ECTAS has been around since 2004 and has now signed up nearly four out of five ECT clinics in England and Wales.

“The ECT Accreditation Service (ECTAS) works with ECT services to assure and improve the quality of the administration of electroconvulsive therapy. We engage staff in a comprehensive process of review, through which good practice and high quality care are recognised and services are supported to identify and address areas for improvement.

Accreditation assures staff, service users and referrers, commissioners and regulators of the quality of the service being provided.”

It is a purely voluntary scheme, and ECT patients cannot choose to treated elsewhere if their clinic is not accredited. ECTAS represents the latest in a number of Royal College of Psychiatrists’ initiatives that began with their first guidelines on the use of ECT in 1977.

Why, nearly 40 years after the introduction of ECT into British hospitals, did the psychiatrists’ professional body suddenly feel the need to produce guidelines on its use? Because someone told them to. The report of an enquiry into St Augustine’s Hospital, Chartham, Kent, which devoted 8 pages to the administration of ECT, had recommended that the College “should give urgent consideration to these problems and issue clear guidance”.

Highlighted in the enquiry’s report was the case of a woman who had died after being forcibly given ECT. (Her psychiatrist had said that he would have “no hesitation in prescribing the same treatment again”.) The College meanwhile had concerns about “certain pressure groups who had been campaigning against the use of ECT”.

These first guidelines (and the College stressed that they were guidelines “rather than hard and fast rules”) came in the form of an 11 page article in the British Journal of Psychiatry. They were followed by an extensive survey of ECT clinics, published in the form of a book of over 150 pages. The survey found that there was a fairly random use of ECT, and that only 22 per cent of ECT clinics actually met the College standards. This guidelines-survey cycle was to be repeated several times over the next 25 years, with the guidelines getting lengthier, the surveys getter shorter, the number of ECT clinics and patients decreasing, and standards gradually improving.

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