ECT in Scotland in 2013

Earlier this month the Scottish ECT Accreditation Network (SEAN) published their annual report on the use of electroconvulsive therapy (ECT) in Scotland, covering the period from January to December 2013. In general the report is much the same as those from previous years. In 2013, 372 people in Scotland received 454 courses of ECT, or 4,145 individual treatments. These figures represent a slight increase on the previous year’s. Much of the increase was accounted for by the Royal Cornhill Hospital in Aberdeen, where psychiatrists were responsible, for example, for 15 of the 20 additional courses.

Women accounted for 70 per cent of the people given ECT in Scotland in 2013. As usual, the report says this is “reflective of the relative incidence of depressive illness in women compared to men”, without giving any statistics to show whether or not this is actually the case as far as people receiving hospital treatment for depression are concerned.

The median age of patients is 60 for men and 61 for women.

As in the previous year, 97 per cent of ECT patients received bilateral ECT (with 92 per cent receiving exclusively bilateral ECT), although this year there is a slightly different explanation:

“Whilst bilateral ECT is recognised to cause more cognitive impairment than unilateral, patients receiving unilateral ECT will require a greater number of treatments as this modality is less effective than bilateral. The consultant responsible for administering ECT thus has to make a clinical decision on an individual patient basis taking into account the relative merits of the different electrode placements. Current practice is entirely acceptable within national guidelines.”

Interestingly there is no mention of patients being involved in the choice between bilateral or unilateral electrode placement.

There has been an increase in the use of maintenance treatment.

Dumfries and Galloway Health Board appears to using ECT at the highest rate and Forth Valley at the lowest rate, just as last year but the gap has narrowed to 4 times. The Royal Edinburgh and the Royal Cornhill hospitals were once again giving the highest numbers of courses, 87 and 51 respectively.

In 2013 one in three people in Scotland who received ECT did not consent, a slight increase over the previous year. This statistic led to a headline in The Scotsman (13 November 2014) “Scots get electric brain shocks against their will”. The article continued:

“SOARING numbers of Scottish patients are receiving electroconvulsive therapy (ECT) – ­despite resisting or refusing the controversial treatment.
Newly released health figures show that in 2013, a third of patients treated with ECT had not given permission for the therapy to be carried out – a rise from 25 per cent in 2010 and 10 per cent in 2006.”

All ECT patients treated without consent in Scotland are deemed to be incapable of giving consent. More than half of them (excluding those treated under urgent provisions”) are described by their psychiatrists as “resisting or objecting”. Newspaper headlines and articles about ECT can be misleading: they don’t always distinguish between someone is who is not consenting and someone who is being treated against their will, or between percentages and numbers (an increase in percentage may not necessarily mean an increase in actual numbers). But in this case there seems to be some truth in headlines. I haven’t found the 2006 figure of 10 per cent they quote, but going back to 1998-1999 only about 15 per cent of ECT courses in Scotland were being given without consent, in spite of the fact that in those days psychiatrists could give ECT to people who were deemed “capable but refusing” as well as those deemed incapable. As for actual numbers of ECT courses without consent in Scotland, there has since 1998-1999 been an increase from about 112 a year to 149 a year. Over the same period the number of courses given to consenting patients has about halved.

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