In my last post I mentioned ECTAS, a voluntary ECT accreditation scheme run by the Royal College of Psychiatrists (the professional body for psychiatrists in the United Kingdom). For the past two years the Royal College has invited accredited clinics to take part in a survey of ECT (electroconvulsive therapy) use. The results of the 2014/15 survey can be seen on the Royal College website.
The survey covered accredited clinics in England, Wales, Northern Ireland and the Republic of Ireland (but not Scotland). There was a response from 81 of the 91 accredited clinics. Not all clinics that administer ECT are accredited, so this represents a lower percentage of all ECT clinics (68 per cent according to the survey). The clinics that responded reported giving 2,148 courses of ECT. What percentage of ECT used in the countries concerned does this represent? It is impossible to say as England does not publish reliable statistics on ECT use. However the Care Quality Commission does publish information on the use of ECT on non-consenting patients under the Mental Health Act and from comparing their statistics with those of the ECTAS survey it would appear that the survey might have picked up – very roughly – about half the total amount of ECT used on non-consenting patients.
Although it allows only a very rough estimate of the numbers of people undergoing ECT, the survey does reveal some interesting facts about how ECT is used in the British Isles today.
Women accounted for 65 per cent of the patients undergoing a course of ECT; this rose to 74 per cent of the 155 patients undergoing maintenance ECT. The mean age of patients receiving a course of ECT was 61 years, and for those undergoing maintenance ECT it was 65 years. There were 3 patients under 18, and 19 patients over the age of 90 years. About half were over the age of 65 years. Some people (179) received more than one course of ECT during the year.
About 90 per cent of patients were being treated for depression. Other diagnoses included schizophrenia, anorexia, adjustment disorder, obsessive-compulsive disorder, persistent delusional disorder, etc. Although ECT is almost universally described as a treatment for severe depression, 30 per cent of patients were described as moderately, or even mildly, ill (on the Clinical Global Impression Scale) before undergoing ECT.
Sixty per cent of the patients undergoing a course of ECT consented to treatment. The other forty per cent were deemed to lack capacity and treated without their consent. Most of the patients treated without their consent were detained and treated under the Mental Health Act. However, about 10 per cent of non-consenting patients were informal, presumably being treated under Common Law. Of the 1,105 ECT patients who were informal and consented to treatment, 21 were detained at the end of the course and 12 had lost capacity. For those undergoing maintenance ECT, 12 per cent were being treated without their consent.
The survey included information on the number of treatments in a course. Although the survey counted only patients who began a course of treatment after 1 April 2014, it does not say whether patients who had not completed their course of treatment before 31 March 2015 were included. Did, for example, the 79 people who had just one or two treatments include people who began treatment in the last week of March, or were they all people whose treatment was terminated prematurely, either because they recovered, decided not to continue, or experienced side effects? The mean number of treatments was 9.5 and the mode, accounting for 25 per cent of courses, was 12. Thirty people had more than 20 treatments, with one person having 66 treatments and one person 76 treatments in the year (this was excluding those undergoing maintenance treatment). Those undergoing maintenance treatment included one person who was having treatment twice weekly, which is the usual frequency for a course of ECT. It didn’t say how long the maintenance ECT lasted.
One notable omission from the survey was any information about electrode placement. If the rest of the British Isles are similar to Scotland, then it would have been nearly always bilateral (but there may be some differences between countries).