ECT under the Mental Health Act in Wales

Yesterday, nearly 17 months after the end of the reporting period, Health Inspectorate Wales (HIW) published their second annual report on monitoring the use of the Mental Health Act, covering the period April 2010-March 2011.

It is a slim volume – 66 pages and some of it copied from the previous annual report. Some things wouldn’t be expected to change from year to year, for example the glossary and the explanation of the Mental Health Act. But should paragraphs such as the following appear two years running?

“Generally we found that the correct legal processes had been followed. However, it is clear that professionals differ in their views as to the circumstances when it is appropriate to use the Act. While we understand the desire to avoid placing the potential stigma of ‘a section’ on a patient when it can be avoided, we have been told by some informal patients (i.e. who are not detained under the Act) that they feel coerced into accepting treatment or staying in hospital informally through being told that they would otherwise be detained.

We also identified a small number of people who had been informal patients for a long period of time. We are concerned that patients in such a position are not afforded the same rights and safeguards as detained patients. We believe that the appropriateness of the status of any long term patient as an informal patient should be reviewed.”

Wouldn’t it be more useful to tell us what has been done about it? Ironically, the BBC chose one of these repeated paragraphs as being particularly newsworthy and, under the headline HIW: Some mental health patients in Wales coerced, began their item on the report by saying: “A watchdog body has criticised the support offered to mental health patients in Wales, claiming some feel coerced into treatment”.

According to the HIW report, there were 78 requests to use electroconvulsive therapy on non-consenting patients in Wales between 1 April 2010 and 30 March 2011, up from 68 the previous year. 49 of these 78 requests were responded to within 2 working days, which is their aim. The report contains no further information on these 78 requests, for example, were the patients concerned men or women, how old were they, which health boards were making the requests?

Before Health Inspectorate Wales was set up, the Mental Health Act was monitored by the Mental Health Act Commission, which covered both Wales and England. Their second report covered the period July 1985-June 1987 and was published in late October 1987, just 4 months after the end of the reporting period, less than one-quarter the time it took HIW to write their second annual report. In that 2 year period (1985-1987), incidentally, there were 270 requests to use drugs or ECT on non-consenting patients under section 58 of the Mental Health Act in Wales. The figure for the two year period 2009-11 is 1,712 (the increase probably being accounted for by requests to use drugs).

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