Last month the Care Quality Commission (CQC) published their annual Mental Health Act (MHA) report, Monitoring of the Mental Health Act 2013/14. It shows, according to the diagram on page 24, that the number of requests to use ECT on non-consenting patients since the law was changed (to exclude capable patients from receiving ECT without their consent) is at a record high.
Here are the figures:
Bizarrely, in spite of these figures, the CQC claims that the use of ECT under the Mental Health Act is in decline. On page 59 for example they say:
“In our previous reports, we have noted the decline in the number of requests for certification of electroconvulsive therapy (ECT). In 2013/14 we arranged an average of 127 SOAD visits each month to consider ECT certification. As there are now more patients detained under the Act than in any previous year, this suggests that detained patients are now less likely to be referred for ECT than in previous years. We have also suggested reasons for this decline may include the falling numbers of beds, the availability of more alternative antidepressants, patient resistance to ECT treatment, or a reduction in the number of ECT facilities.” [Here there is a reference to a previous report which is actually discussing the decline in use of ECT with consent, rather than ECT without consent.]
Over the past 30 years or so the use of ECT on consenting patients in England has declined by over 75 per cent, while the numbers of people considered incapacitated who are given ECT without their consent has remained about the same. Nobody has looked at why this has happened.
A law change, implemented in November 2008, removed capable patients from the provisions of Section 58 of the MHA. Before this change, requests to use ECT under the MHA were running at about 2,000 a year. Of these, about 40 per cent were for patients who were deemed capable but refusing, leaving about 1,200 patients a year who were deemed to lack capacity. So it could well be that this latest figure from the CQC represents a record high for the use of ECT on incapacitated patients in England not just since the CQC’s first report in 2009/10 but since the Mental Health Act 1983 was introduced.