Electro-convulsive Therapy (Restrictions on Use) (Hansard, 3 December 1997)

§ Mr. John Gunnell (Morley and Rothwell)

I beg to move, That leave be given to bring in a Bill to amend the Mental Health Act 1983 to prescribe the circumstances in which electro-convulsive therapy may be used without the patient's consent; to establish who may administer it; to lay down requirements governing the apparatus with which it is administered; and for related purposes. Electro-convulsive therapy is usually carried out under anaesthetic. The patient is strapped down and an electric current is passed through the brain, causing a convulsion. In 1990–91, the last year for which figures are available, 105,466 treatments were administered to an estimated 20,000 patients.

ECT is given to patients suffering severe depressive illness. The increased effectiveness of anti-depressant drugs has resulted in a reduced use of ECT, but its present level of use is not known because the previous Government stopped collecting data centrally.

In January this year, the Royal College of Psychiatrists completed its as yet unpublished third audit of ECT clinics in England and Wales. It revealed that 45 per cent. of junior doctors lack knowledge about one or more basic issue related to effective administration of ECT. The audit's authors say that for maximum efficacy and minimal side-effects those administering ECT should fully understand such issues and have access to, and training in the use of, appropriate equipment." Although all mental services now have a named consultant psychiatrist responsible for the ECT clinic, routine ECT treatment will usually be given by junior doctors. According to a Royal College of Psychiatrists press release, the third audit found that a majority of ECT machines met what was the then college standard, but in August this year one of the audit's co-authors told me that a more recently completed survey had revealed that 53 per cent. of ECT machines were obsolete.

In other words, in our hospital system, ECT treatment may be carried out with or without the patient's consent on equipment that is out of date and is administered by doctors who often do not have adequate training.

I submit that if that had happened in any other field of medicine, public opinion would have focused on it and found it wholly unacceptable. ECT continues, however, without any legal mechanism for improving the circumstances in which it is prescribed and carried out—perhaps because of the stigma attached to the mentally ill.

Data on ECT may be collected, but they are not held centrally. Inquiries to a specific trust or unit may be answered, but it is impossible to get a sense of the national picture. My Bill would establish a legal obligation on all hospitals to supply the Department of Health with detailed information on every patient in receipt of ECT and on the Department to publish an annual record, broken down according to gender, age and race, with an assessment of outcome.

The Royal College of Psychiatrists "ECT Handbook" publishes a suggested treatment record form for clinics to use. It includes space for an assessment of outcome to be 394 completed by both the patient and the responsible medical officer. My Bill would make the reporting, collating and central publication of such information compulsory.

There is a need for a change in practice. The Royal College of Psychiatrists, following its audits during the past 17 years, has given some clinics a yellow card—even a repeated yellow card—but there is no statutory means of giving a red card. Without that sanction, how effective can a warning be?

Should ECT be used at all? Some may have reservations about my Bill because it does not ban ECT, as has been done in some countries, such as Germany and Holland. It is commonly accepted in Britain today that, where possible, medicine should be evidence based. Enough examples are reported of patients who believe that their lives have been irreparably damaged by ECT. I have received a number of such letters and reports, and they are harrowing.

Such evidence is, of course, anecdotal, but there are enough anecdotes at least to raise serious questions. The wording of the Mental Health Act 1983 suggests that ECT would not be legal at all under emergency procedures if the changes to the patient it brings about are found to be irreversible. Some hard evidence is required.

For its part, the Royal College of Psychiatrists claims "rock solid" evidence that ECT works. It also argues that claims of side effects such as memory loss are attributable to the patient's depressive disorder. I note that the Royal College of Psychiatrists cites as the "best evidence to date" of ECT's success in treating severe depressive illness a 15-year-old piece of research it conceives can be criticised. With proper data collection and measurement of individual outcomes, my Bill would help to ascertain ECT's effectiveness and whether its effects are reversible.

My Bill proposes some limitation on the relative ease with which ECT can be given. At present, if a patient consents, ECT can be given without the agreement of a second opinion appointed doctor. The consent principle in the Mental Health Act 1983 can also be overridden by detaining the patient and treating them under the patient's best interest principle. While a risk of suicide, self harm or danger to others understandably requires the putting to one side of the consent principle, it is disturbing that that can occur simply because it is thought that the patient's health may improve if they are given ECT.

At the time of the debate on what became the Mental Health Act 1983, the right hon. and learned Member for Rushcliffe (Mr. Clarke), then the Secretary of State for Health, said that he had decided not to include ECT under treatments requiring both consent and a second opinion but as experience is acquired, and if opinion changes, we shall be able to move it into the more serious …category."—[Official Report, 18 October 1982; Vol. 29, c. 86.] My Bill would take us to the situation that the right hon. and learned Gentleman envisaged might be necessary. It would also ensure that ECT is carried out in safe circumstances and that the patient can be given ECT only if he or she has given informed consent and if a second opinion appointed doctor agrees, unless urgent treatment is judged necessary by the responsible medical officer.

Question put and agreed to.

Bill ordered to be brought in by Mr. John Gunnell, Mr. David Hinchliffe, Mr. Andrew Rowe, Audrey Wise, Mr. Paul Burstow, Mr. Peter Bradley, Mr. John Austin, Miss Melanie Johnson, Mr. John McAllion, Mr. Gordon Marsden, Mr. Ken Purchase and Mr. Neil Gerrard.