On Monday 17th April 2017 The Guardian newspaper ran an article about electroconvulsive therapy (ECT) under the heading: “Electroconvulsive therapy on the rise again in England: ECT stages comeback after years of decline, with thousands treated on NHS despite lack of scientific explanation for effects”. The text of the article contained the claim that ECT “is enjoying a revival”. But do the facts support these comeback and revival claims?
The authors of the article, Nicola Davis and Pamela Duncan, had sent a freedom of information request to mental health trusts asking about their use of ECT over the past few years and received a usable reply from 44 trusts
“Exclusive data covering four-fifths of NHS mental health trusts in England shows that more than 22,600 individual ECT treatments were carried out in 2015-16, a rise of 11% from four years ago, when about 20,400 were carried out. The number of patients treated also rose, albeit more modestly, to more than 2,200, suggesting that on average individuals undergo more ECT procedures than before. The figures, obtained through freedom of information requests, show that despite being a crude, controversial treatment, which fell sharply out of favour around the turn of the millennium, ECT is enjoying a revival… After considerable fluctuation over the last four years, a comparison of figures from 2012-13 and 2015-16 reveals an 11% rise when it comes to the number of ECT treatments. Almost two-thirds of NHS trusts reported a rise in the number of ECT treatments carried out over the four-year period. The average number of ECT treatments per patient also rose, from 9.6 in 2012-13 to 10.1 four years later.”
The article did not contain any information about the use of ECT in the past, although information is readily available. Until 1991 the Department of Health collected and published reasonably accurate statistics on the use of electroconvulsive therapy in England. That year, there were about 16,000 courses of ECT, down from about 25,000 ten years earlier, but still more than five times higher than The Guardian’s figure, even allowing for missing fifth of trusts. The Department of Health later carried out two surveys of ECT use, in 1999 and 2002, by which time ECT use had further fallen to about 9,200 patients in 2002. And in 2009 the Royal College of Psychiatrists conducted a survey and concluded that between 5,100 and 6,720 people received ECT, still about twice as high as The Guardian’s figures. So, if ECT is making a comeback, it has quite a way to go, even to reach its level of eight years ago. It would have been more realistic to suggest that, after decades of declining use, ECT use may have levelled off.
A five per cent increase in the number of patients receiving ECT over four years probably is not large enough to be certain that ECT is making a comeback. (The other five per cent increase was accounted for by lengthening of courses by on average about half a treatment.) But are the figures provided by the trusts even accurate? The authors of the article say that two trusts “provided data that turned out to be completely incorrect, only providing accurate figures after multiple contacts”. Would they have recognised less startling errors? The authors don’t mention the fact that the Care Quality Commission keeps reasonably accurate track of the number of people being given ECT without their consent under the Mental Health Act. Comparison of the two sets of figures is a rough and ready way of seeing if the trusts’ figures are likely to be reasonable.
The authors comment on the difficulties of obtaining information:
“Three trusts refused the request outright, saying the staff time required to comply with the request was too great, while seven trusts could not even provide consistent data from 2012-13 onwards. Some trusts admitted they were missing data over periods of months in certain years.”
All trusts are supposed to record ECT use (code 83.8 for the first treatment and 83.9 for subsequent treatments in a course) and submit the data to the Health and Social Care Information Centre (HSCIC), so the information should be available at the click of a mouse, but it seems that some trusts don’t bother to submit data to HSCIC or do it incorrectly. The information the authors were looking for should have been available from the HSCIC website without the need to put in Freedom of Information requests, but, as long as trusts don’t submit accurate codes (or any at all) the HSCIC figures are not useful. As the authors conclude:
“This project may have revealed an increase in ECT use in England but it has also uncovered a lack of properly collected data relating to the procedure.”