SOARING numbers of Scottish patients are receiving electroconvulsive therapy (ECT) – despite resisting or refusing the controversial treatment.
Newly released health figures showthat in 2013, a third of patients treated with ECT had not given permission for the therapy to be carried out – a rise from 25 per cent in 2010 and 10 per cent in 2006. According to the report, by the NHS Information Services Division, 372 patients received ECT in Scotland last year, with only 67 per cent giving their “informed consent”. Patients that refuse the treatment can be forcibly held down and anaesthetised for the procedure.
Politicians and health campaigners have called the statistics “disturbing,” but health authorities said treatment without consent is only given if it is in the best interests of the patient.
The treatment involves a small electric current being run through the brain with the aim of producing a seizure. It can be used by doctors to help treat severe depression, schizophrenia, bipolar and those at serious risk of suicide. It has been used by psychiatric doctors since the 1930s.
It is a risky treatment and more than half of patients suffer side-effects, most commonly headaches, nausea and muscle pain.
More severe side-effects include seizures, heart problems, memory loss and personality change. Last year, Aberdeen University researchers discovered ECT therapy works for severely depressed or mentally ill people by turning down an overactive connection between areas of the brain that control mood as well as thinking and concentration. They argued it was an effective tool in somepatientsbecause it stopped the impact that depression has on that person’s ability to enjoy life.
Families are unable to refuse or agree to the treatment on a patient’s behalf, as power of attorney is exempt under current mental health legislation.
The report explained: “If the patient is not capable of providing informed consent, treatment must be authorised by an independent psychiatric opinion.”
Alison McInnes, MSP and Liberal Democrat justice spokeswoman, said: “I find these figures disturbing. It is a hugely controversial treatment and I don’t think people should be given it without their full consent.
“The fact families are not able to refuse the treatment on the patient’s behalf is also something that needs to be looked at. “There are humanrightsissues that should be looked into, but unfortunately this is a very neglected issue and often these patients don’t have anyone speaking up for them.”
Scottish Conservative health spokesman Jackson Carlaw said: “Every situation will be different and there’s no doubt some of these patients will present extreme challenges to health professionals.
“But I think the public will look at these statistics and think we should be reducing the number of those who receive this care without granting the go-ahead.” scotsman
Every year Scottish psychiatrists produce a report on the use of ECT in Scotland. This year’s report, published earlier this month, reports on the use of ECT in Scotland during 2014. There has been very little change in the amount of ECT used since the previous year: the number of patients and courses were down slightly, but the total number of treatments up slightly. During 2014, 357 people received 434 courses of treatment, or 4,443 individual treatments.
As in previous years, women accounted for more than two-thirds of ECT patients. Just over one in three ECT patients did not consent to treatment but were deemed to lack capacity and given the treatment without their consent and sometimes in spite of the fact that they were refusing or resisting the treatment.
ECT patients in Scotland are getting older. In 2014 the mean age of consenting ECT patients was 58 years and of non-consenting patients 67, up from 57 and 64 respectively in 2013. About 24 per cent of ECT patients in 2014 were aged under 50, about 45 per cent aged between 50 and 70, and about 31 per cent aged over 70. If you are a woman over 80 in Scotland, you are more likely to get ECT than if you are a woman under 40. It is interesting to compare these figures to those from Texas, one of the few other places to produce annual statistics on ECT use. The rate of ECT use in Scotland and Texas is much the same; and guidelines, etc., produced by British and American psychiatrists would appear to show in theory a broad agreement about its use. But in practice ECT is being given to different groups of people: Scottish patients are older, and their age is increasing, and they are much less likely to consent to treatment than patients in Texas.
In Scotland unilateral ECT is seldom used: just one in 25 patients received a course of treatment consisting entirely of unilateral treatment.