In their most recent annual report on the monitoring of the Mental Health Act in England,
published earlier this month, the Care Quality Commission (CQC) has admitted that the use of electroconvulsive therapy (ECT) on non-consenting patients in England is increasing. The CQC oversees the system whereby psychiatrists on their panel, the second opinion appointed psychiatrists or SOADs, approve the use of ECT on patients who are deemed to lack the capacity to make a decision about their treatment. In 2014-15 there were 1,631 requests to approve ECT for non-consenting patients, up from 1,521 the previous year – an increase of about 7 per cent. This is what the report says about the increase (page 18):
In our 2011/12 report, we noted that over the previous decade there had been an overall decline in the number of SOAD visits to review the use of electroconvulsive therapy (ECT). However, over the last three years we have seen the figures begin to rise again, with 1,631 visits last year for detained patients. To explore possible reasons for this change, we will be looking more closely at our national data on ECT second opinions, for example to see whether there are regional differences and will discuss our findings with the Department of Health.
In about 5 per cent of visits, the report goes on to say, the SOAD did not authorise the use of ECT.
The decline in SOAD visits over the previous decade is in fact due to a change in the law, implemented in 2008, which meant that psychiatrists could no longer use the SOAD system to give ECT to capable patients who didn’t want it. There was no decline in the use of ECT on incapable patients, and the latest figure is probably the highest since 1983, when the SOAD system was introduced. Meanwhile the use of ECT on consenting patients has declined significantly, probably by over 75 per cent or so since 1983.
Psychiatrists also have to seek approval from the CQC for the use of psychosurgery (which can only be used when a patient consents). The CQC reported (page 19) that they had received four requests for surgery, all of which had been approved.