Answers to questions about ECT in Scotland

The Scottish Parliament has now come up with answers to some of the nine questions on electroconvulsive therapy (ECT) posed by Liberal Democrat SMP Alison McInnes in October. The questions were:

1: To ask the Scottish Government what tests mental health professionals are required to apply when determining whether or not a patient has the capacity to consent to or refuse electroconvulsive therapy.

2: To ask the Scottish Government whether medical professionals treating patients with electroconvulsive therapy are required to tell them that it can lead to permanent memory loss.

3: To ask the Scottish Government whether it has conducted research on whether patients treated with electroconvulsive therapy have subsequently experienced post-traumatic stress disorder.

4: To ask the Scottish Government whether it considers that the use of electroconvulsive therapy in the absence of informed consent constitutes inhuman or degrading treatment.

5: To ask the Scottish Government how many days on average a course of electroconvulsive therapy lasts and how many times the therapy will be applied during that period.

6: To ask the Scottish Government what percentage of patients treated with electroconvulsive therapy for depression relapses within 12 months.

7: To ask the Scottish Government what percentage of patients treated with electroconvulsive therapy commits suicide.

8: To ask the Scottish Government what the mortality rate is among patients over 65 who are receiving electroconvulsive therapy.

9: To ask the Scottish Government how many times a designated medical practitioner (a) refused and (b) agreed to certify that it was necessary to give electroconvulsive therapy to a patient who resisted or objected to the treatment, in the last year for which information is available.

The answer to question 1 started by saying “All patients who receive ECT must either give informed consent or be protected by the legal safeguards within the Adults with Incapacity (Scotland) Act 2000 and the Mental Health (Care and Treatment) (Scotland) Act 2003”. The problems with the concept of “informed consent” were immediately highlighted by the answer to question 2: “While there is no evidence of permanent memory loss, electroconvulsive therapy can cause short or long term memory loss”, with no attempt to explain at what stage long term becomes permanent.

The answer to question 3 was “no”.

The answer to question 4 was several paragraphs defending the use of ECT with talk about “continuous improvement of services” and “good practice”, etc. That can be taken as a “no”.

In answer to question 5 it was said that the average number of treatments in a course was 8, usually given twice a week, and there was a mention of maintenance ECT.

The answer to question 6 was “The information requested is not held centrally”.

The answer to question 7 was rather odd. It started by saying how Healthcare Improvement Scotland was trying to reduce the risk of suicide, and then went on to say information on the number of people committing suicide during a course of ECT was not available, before concluding: “In interpreting this information it should be noted that in such circumstances there may be no causal link between ECT and the suicide; and that there is a strong association between major depression and suicide.” What information? None has been given. Or perhaps they were thinking of the Mental Welfare Commission’s annual report which mentioned an investigation into the case of a woman who had committed suicide while being treated with ECT (…”we decided that there had been no deficiency of care and treatment. There were some learning points…”)

The answer to question 8 was perhaps the most informative of them all:

“During the period 2005 to 2011 the Scottish ECT Accreditation Network database recorded six deaths for patients aged over 65 years. Electroconvulsive treatment (ECT) was not indicated as being related to the cause of death of each patient. Co-morbidity may have been a factor in the deaths of these patients. There are approximately 350-450 patients receiving episodes of ECT each year and approximately 3,400-4,200 treatments per year. Mortality rates among patients who received ECT treatment but who are subsequently discharged from hospital are not captured by the SEAN database.”

It would have been helpful if they had said how many courses of ECT had been given to people over the age of 65 during the period of 2005 to 2011. My guess, if 2005 to 2011 is a seven-year period, then the number would be perhaps be somewhere in the region of 1,200. Six deaths occurring in 1,200 courses would be about 1 in 200 courses, a much higher rate than psychiatrists are usually prepared to admit to. And that is only counting those who died in hospital.

The final question received a “The information requested is not held centrally” answer. Why? I find it hard to believe that the Mental Welfare Commission doesn’t count the number of T3 forms they issue and the number they don’t (since their psychiatrists presumably have to be paid for a visit regardless of the outcome).

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