ECT For Serious Mental Disorders Given Ok
22 March 2005
ELECTROCONVULSIVE THERAPY FOR SERIOUS MENTAL DISORDERS GIVEN OK
An independent report into electroconvulsive therapy (ECT) recommends its continued use as a safe and effective treatment particularly for severe depression, though it recommends some regulatory changes.
Deputy Director of Mental Health, Dr Jeremy Skipworth welcomes the report. ?I am pleased that this important and sometimes lifesaving means of treating some forms of serious mental illness continues to be recognised as effective and is being delivered safely in New Zealand?.
Dr Skipworth says the report's recommendations seeking regulatory change would require further public debate, particularly as they would signal wider changes in clinical practice.
Two other reports regarding ECT have also been completed. The report on an audit of ECT delivery has been released. The other report, on annual statistics on ECT use in New Zealand over 2003-2004, and will be released next month.
These reports meet two recommendations of the Health Select Committee following its consideration of a petition to ban ECT in February 2003. Reports can be accessed on the Ministry of Health website (www.moh.govt.nz).
Independent review of ECT
The independent review of the medical evidence for ECT concluded that its use is appropriate for treating some serious mental disorders, and banning its use would deprive some seriously ill patients of a potentially effective and sometimes lifesaving means of treatment.
The review group considered the current regulatory controls for ECT needed to change. They recommend that where possible ECT use should only be administered with the patient?s consent, noting that patients should be able to refuse treatment in advance when regarded as competent to make this decision.
Dr Skipworth says this change would require changes to the law and should be more widely debated. In the interim, guidelines and standards would be reviewed to ensure greater clarity around issues of informed consent.
Annual ECT statistics
The Health Select Committee recommended consistent monitoring, collecting and recording of national data on ECT, to be reported each year. The first annual report gives a breakdown of the number of people receiving ECT and also the number receiving ECT under compulsion. In the 12 months to 30 June 2004, 305 people received ECT. This report will be released next month.
ECT delivery audit
In mid-2002 the Ministry of Health established baseline data on the quality of ECT delivery. The audit concluded that ECT is being delivered safely in New Zealand, while highlighting areas of service delivery that could be improved. Already changes have been implemented as a result of feedback provided from the audit to District Health Boards.
When is ECT used?
ECT is used mainly in the treatment of severe depressive episodes. It is used when antidepressant medication has not been effective, the severity of symptoms means it is not possible to wait for the effects of such medication to become apparent, or the side-effects to or risks associated with medication make ECT the most appropriate treatment option. Severe depression is frequently linked with self-harm or suicide.
What happens during an ECT treatment?
It involves the passage of an electric current across the head of a person to produce a convulsion. The treatment is painless, as the individual is given general anaesthetic and muscle relaxant before and during ECT.
How many people receive ECT in New Zealand?
The total number of people who received ECT from 1 July 2003 ? 30 June 2004 was 305 or 7.5 people per 100,000. The average number of treatments per person was just over 10. Statistics gathered for the Ministry of Health ECT audit show 414 people received ECT during the 12 months ending 30 June 2002.
Why was an independent review of ECT undertaken?
ECT by its very nature arouses anxiety in patients and families as well as a high degree of interest from the public despite numerous reviews of published studies showing ECT is a safe and important treatment option. Because of this high level of public interest the Government agreed to the Health Select Committee?s recommendation for a comprehensive review of New Zealand and overseas literature and of legislation to ascertain the effectiveness and safety of ECT and of the regulations surrounding the use of this treatment.
Who conducted the independent review?
Professor Craig Anderson, formerly of Auckland University and now at the George Institute for International Health, Sydney, chaired the review. Other members of the review group were Peter Skegg, Professor of Law at the University of Otago who has particular expertise in medical law and ethics, and Ranui Wilson, a mental health consumer expert from Christchurch.
What type of review was undertaken?
The review looked at evidence from the published scientific literature regarding ECT and compared the legislative frameworks that regulate the use of ECT in various countries. In reviewing the scientific evidence the review group used the guidelines methodology of the New Zealand Guidelines Group (www.nzgg.org.nz). In order to obtain a wider view of ECT among consumers and other members of the public, a series of focus groups were held throughout the country in June 2004.
Will the Ministry of Health amend the guidelines to the Mental Health Act?
The Ministry of Health notes the review team?s recommendation that the Mental Health (Compulsory Assessment and Treatment) Act 1992 be changed to ensure that ECT cannot be given to competent patients without their consent, and that advance directives made by an appropriately informed and competent person should be legally binding. The Ministry will review the guidelines to the Act and make such appropriate amendments as are possible within the current law.
Will the Ministry of Health recommend amending the Mental Health Act to give effect to the review team?s recommendations re consent and advance directives?
The Ministry of Health considers that the consent issues raised by the review group are fundamental, not just to ECT, but for all mental health treatments involving a degree of compulsion. The review report lists a number of countries and states where a competent person can override the recommendation of doctors wishing to provide treatment. Some of these jurisdictions have been criticised for allowing prolonged suffering and detention of mental health consumers who refuse treatment. Similar recommendations were considered in the drafting of our current Mental Health Act. A careful analysis of the advantages and disadvantages of further strengthening the rights of mental health patients in the way proposed would be required before any such amendment to the Act could be recommended.