ECT in Scotland in 2011

Earlier this month the Scottish ECT accreditation Network (SEAN)
published their annual report on the use of ECT on Scotland, covering the period from January to December 2011. In 2011 in Scotland electroconvulsive therapy (ECT) was given to 370 people, who received 451 courses of treatment or 4,755 individual treatments. This is a decrease from 2010, when 418 people were given ECT.
Otherwise, little has changed. The median number of treatments per course was 10.1; 71 per cent of patients were women; the median age of patients was 58; 97 per cent of courses involved bilateral ECT. Twenty-one people were receiving maintenance ECT.
The heaviest users were the Dumfries and Galloway area, and the Grampian area (which also treats patients from Orkney and the Shetlands), using ECT at more than five times the rate of the lowest user, the Forth Valley area.

Two-thirds of the courses of ECT were given to people who consented to treatment. Under Scottish law someone must be deemed incapable of consenting before they can be given ECT without their consent; it cannot be given to people who are considered capable and saying no. Fourteen of the 153 people who didn’t consent were informal patients, 33 were detained patients who were not objecting to or resisting ECT , 55 were detained patients who were objecting to or resisting ECT. These three groups were given ECT after a psychiatrist from the Mental Welfare Commission had given permission for the treatment to go ahead. A further 51 people were treated without their consent and without a visit from a psychiatrist from the Mental Welfare Commission because their psychiatrist thought they need ECT urgently.

Only a minority (34 per cent) of patients who lacked capacity had regained it by the end of their treatment, although “77% of patients without capacity completing an episode of ECT experienced a 50% improvement in MADRS scores”. The authors say: “Therefore, it can be stated with confidence that people who lack capacity benefit from ECT even more than those who retain capacity.” But it seems odd that a treatment which is supposed to be helping incapacitated people so much does not restore them to capacity. The authors though did not say how many of the people who lack capacity are incapacitated because of their illness (for example, because of psychotic symptoms) and how many are incapacitated because of something else (for example, a learning disability) in which case you wouldn’t expect treatment to restore them to capacity.

The diagram (figure 2.1) showing how many patients consented to treatment and how many were treated without their consent (under s48 for informal patients, and with forms T3A, T3B and T4 according to whether or not they were formal or informal patients, objecting or resisting, etc) is curiously labelled “Patient Consent Type”. There is only one “type” of consent: a capable patient says yes. All the rest are ways of legally treating patients without their consent, rather than “types of consent”.

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