ECT in Northern Ireland

In 2005 a question about the numbers of people undergoing electroconvulsive therapy (ECT) in Northern Ireland was asked in parliament. The answer showed that, between 1994/5 and 2004/5, the use of ECT dropped by more than a half – from 1,039 courses to 472 courses (which still left Northern Ireland using significantly more ECT than the rest of the United Kingdom at that time).

In October the Regulation and Quality Improvement Authority (RQIA) published a report on the administration of ECT in Northern Ireland. This report shows a further drop in the use of ECT to 168 patients in 2010/11 and 147 in 2011/12 (putting ECT use on a level with Scotland). The figures from the parliamentary answer and the RQIA report are not directly comparable as the former refer to courses and the latter to patients (who may have more than one course in a year) but they nevertheless show that ECT use has dropped by about 80 per cent over a seventeen-year period.

Patients ranged in age from 22 to 95 years, and 68 per cent were women. About 25 per cent of the patients did not consent to ECT and were treated with the approval of a psychiatrist from the RQIA. Northern Ireland is now the only country in the United Kingdom which still allows the use on ECT without consent on patients who retain capacity but do not wish to have ECT (that is, “capable but refusing”). The report did not say how many patients were incapable of consenting to treatment and how many were refusing. 94 per cent of patients received bilateral ECT. The report says this about electrode placement:

“The decision about whether treatment is administered using bilateral or unilateral electrode placement will depend on a number of factors, but is mostly dependent on the desire to lessen the cognitive side effects.”

Presumably psychiatrists in Northern Ireland are remarkably free from any desire to lessen the cognitive side effects of ECT.

The highest using trust (Western Health and Social Care Trust) used ECT at more than three times the rate of the lowest using trust (South Eastern Health and Social Care Trust). The lowest using trust was incidentally one of only two in Northern Ireland whose ECT clinics were accredited by the Royal College of Psychiatrists’ ECT Accreditation Service. The pattern of ECT in the South Eastern Health and Social Care Trust appears to be rather strange – in 2011/12 they gave ECT to 5 consenting patients and 8 non-consenting patients.

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