The Supreme Court of Victoria, Australia, has today (14 August 2017) been hearing a case involving electroconvulsive therapy (ECT) brought by Victoria Legal Aid. Two people who did not want ECT had the treatment ordered by the Mental Health Tribunal, and their appeals were rejected by the Victorian Civil and Administrative Tribunal. One of them has already had ECT and the other has not yet started treatment. Both have been given a diagnosis of schizophrenia. The case is explained by Victoria Legal Aid here.
The 2014 Mental Health Act established a system whereby Mental Health Tribunals consisting of a legal member, a psychiatrist and a community member, authorise the use of ECT on non-consenting patients as long as they are considered to lack capacity to make a decision and ECT is considered the least restrictive treatment available. In some ways it is similar to the system in England, Wales and Scotland, with a three-person tribunal replacing the one person (a psychiatrist) who authorises treatment. In most cases in Victoria the tribunal does indeed authorise treatment, although the proportion drops considerably when the patient has legal representation. According to Victoria Legal Aid: “In 2015-16, the tribunal conducted 707 ECT hearings. It made orders for ECT in 620 cases (88 per cent) and refused applications in 86 cases (12 per cent).”
The population of Victoria is about 5.8 million and 620 courses of ECT were given without consent. Scotland has a fairly similar sized population (about 5.3 million) and yet in 2015 there were 170 courses of ECT given without consent. And in Texas (population 28 million) 25 people were given ECT without their consent. In New Zealand (population 4.7 million) 71 people received ECT without their consent. So why is Victoria using ECT without consent on so many more people than other places?
ECT involves giving someone a powerful electric shock, using a current of about 800 milliamps. The Victoria state government tries to disguise this fact:
“ECT is a medical procedure in which a person’s brain is stimulated with a brief, controlled series of electrical pulses using electrodes placed at precise locations on the person’s head. This stimulus causes a seizure within the brain. ECT is always performed under general anaesthetic and with a muscle relaxant, which prevents the person from feeling any pain and prevents the person’s body from convulsing.”
Would, I wondered, Victoria Legal Aid be more accurate? Actually they manage to avoid mentioning the electric shock at all:
“Electroconvulsive treatment is a medical procedure to induce a seizure within the brain, aimed at reducing some of the symptoms of mental illness. It is performed under general anaesthetic.”