For some years now Scotland has been producing annual statistics on the use of electroconvulsive therapy (ECT) but relatively little has been published about its use in other parts of the United Kingdom. That, at least, is what I thought but it seems that I had missed something. In August 2013 the Royal College of Psychiatrists published the results of a survey of ECT use in 78 clinics in England and Wales over the period April 2012 to March 2013.
The 78 clinics which took part were those who were signed up to the Royal College’s ECT Accreditation Service (ECTAS). There are apparently 104 ECT clinics in England and Wales, so 78 represents about three-quarters of them. The survey doesn’t therefore give figures for the total ECT use in England, but does give some information about who gets ECT.
The survey looked at 1,895 courses (17,043 individual treatments) of ECT given to 1,729 people. Nearly ten per cent of people had more than one course during the year. Women accounted for 66 per cent of courses.
58 per cent of the courses were given to people aged over 60. 32 per cent were given to people aged 40-60 and 10 per cent given to people aged under 40. One person under the age of 18 received ECT. The vast majority had a diagnosis of depression or bipolar disorder, etc., but a few people were being treated for schizophrenia or other disorders. Just over 40 per cent of the courses were given to people who had not consented to treatment .
The mean number of treatments per acute course was 9.3. However, 12 treatments per course was by far the most popular choice for psychiatrists – one quarter of patients received this number. Fifteen per cent of patients received fewer than 6 treatments, and 47 per cent received between 6 and 11 treatments. 9 per cent of patients received more than 12 treatments. This last group included one person receiving 48 treatments, one person receiving 33, 2 people receiving 31 and 4 people receiving 30 treatments – all in an acute course (maintenance ECT was surveyed separately).
Most perplexing was the fact that, at the beginning of an acute course, 2 patients were rated as “normal, not at all ill”, a further 10 as “borderline mentally ill”, and a further 43 as mildly ill. 559 people were rated as moderately ill, 896 as severely ill and 342 as “amongst the most severely ill”. These figures give the lie to the claim, so often repeated in patient information leaflets, that ECT is only given to people who are severely ill.
146 people were being given maintenance ECT. They tended to be older and more likely to be women than those undergoing acute courses. 70 per cent were aged over 60, and 74 per cent were women. 15 per cent were unable to consent. Half were having treatments more frequently than once every 3 weeks.
As so often with ECT statistics there is something that doesn’t quite add up. This survey covers the same time period as the Care Quality Commission (CQC) Monitoring the Mental Health Act in 2012/13 report. The CQC report says that they made 1,464 visits to detained patients to authorise ECT during that period. Yet the ECTAS survey shows only 703 detained patients receiving ECT without their consent (that is, those who would need the CQC psychiatrist visit. That would suggest that the clinics that were not included in the ECTAS survey might be using more ECT than those that were included – or that somehow the survey wasn’t counting all the patients in the clinics that took part.
Comparing the ECTAS statistics with those from a Department of Health survey ten years previously a few things stand out – patients are, on average, getting slightly older; courses of ECT are getting much longer (9.3 treatments per course on average compared to 5.6 ten years earlier) and the proportion of patients who are treated without their consent has nearly doubled.
While writing this I have been listening to the radio in the background. There is a programme on about concussions in sport and I just caught the words, and I didn’t catch who they came from: “the brain is phenomenally complex and phenomenally fragile; it doesn’t take much to disturb it”.