ECT without consent in Australia

Earlier this month the Australian newspaper The Age published an article entitled “Reforms to give consumers a say”, which said:

‘A NEW tribunal will be required to approve electroconvulsive therapy treatment for involuntary patients as part of an overhaul of Victoria’s mental health laws announced by the state government.

Victoria is the only jurisdiction in Australia that allows ECT without the consent of the patient and without either an external review from a tribunal or a second psychiatrist….

Speaking to The Age about the reforms, Royal Australian and New Zealand College of Psychiatrists spokesman Malcolm Hopwood said ECT was an effective and sometimes life-saving treatment for severe mental illness.
”It is a significant change to require the authority of a tribunal to proceed, and we’ll obviously be looking very closely at the detail of how that’s going to be governed, and provisions around cases that require immediate treatment,” he said.

Associate Professor Hopwood welcomed the government’s decision not to proceed with penalties of up to a year’s jail for psychiatrists who breached ECT regulations. He said there were more appropriate mechanisms for dealing with bad practice, including through the medical board.’

Although the article says that “Victoria is the only jurisdiction in Australia that allows ECT without the consent of the patient and without either an external review from a tribunal or a second psychiatrist”, I suspect that other jurisdictions allow the external review to be dispensed with when a psychiatrist decides that a patient needs ECT urgently (South Australia certainly does).

The chief psychiatrist’s annual report for 2010-11 (published in June 2012) had this to say about the numbers of people in Victoria given ECT without their consent:

‘Sixty-five per cent of all ECT treatments in 2010–11 were administered to patients who had consented to their own treatment; and 35 per cent to involuntary patients, where the authorised psychiatrist consented on their behalf. Involuntary treatment can only occur in a public mental health service proclaimed under the Act.’

Presumably they mean 65 per cent of all ECT treatment in the public sector (in which 62 per cent of all ECT was given). In total, there were 19,912 individual treatments in Victoria during the year, very slightly up from the previous year. These treatments were given to 1,721 patients, that is, a mean of 11 treatments per patient which is higher than in other countries. One major change is that no-one under the age of eighteen received ECT (compared to 7 teenagers under 18 in 2009-10, the youngest of them 13, receiving 83 treatments). The report explains:

‘In April 2011 the ECT subcommittee of the QAC [Quality Assurance Committee] proposed a new guideline, requiring mental health services to notify the Chief Psychiatrist and to seek a second opinion from a child psychiatrist before providing ECT to a person under the age of 18 years. The QAC endorsed this recommendation at its meeting of 15 June 2011. As this guideline was issued towards the end the reporting period, its introduction does not explain the reversal of the previous trend. Some clinical leaders believe that the difference may stem from the changing clinical profile of the young persons presenting in any given year; others hold the view that mental health services may be changing their practice in this area in anticipation of the new legislation, which is expected to introduce more stringent controls and safeguards regarding the provision of ECT. In the absence of clear evidence, either of these possible explanations must, for the time being, be regarded as conjectural.’

All Australian states have chief psychiatrists, but I have only been able to find one other annual report, that of the chief psychiatrist of South Australia:

‘A total of 6393 ECT treatments were given in the 2010-2011 period. Of these, 3749 (58.6%)  treatments were provided by public mental health services and 2644 (41.4%) by private psychiatric hospitals.’

Given the difference in population, these figures are not far off those of Victoria. South Australia does not however collect information on the number of people receiving ECT.
In South Australia 20 per cent of ECT was given to patients who hadn’t consented (again not that different to Victoria, if South Australia’s percentage is for all ECT and Victoria’s for ECT in the public sector).

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