§ Mr. Walter Johnsonasked the Secretary of State for Social Services, on the basis of the Trent Region Health Authority population/bed norms, what are the deficiencies in the main specialities in the South Derbyshire Health District.
§ Dr. OwenThe information based on the mid-1974 estimated resident population and on the beds available in November/December 1975 for the Derbyshire South Health District, is as follows:
age; and what guidance she has given to the NHS hospitals as a result.
§ Dr. OwenI am aware of this article, which referred to a study in the United States of America involving patients suffering from schizophrenia who had received electro-convulsive therapy (ECT) before 1966. Each patient had received an average of 58.5 treatments using the bilateral technique. The conclusions of the study were only indicative.
In this country ECT tends to be used for the affective disorders such as depression, and the average number of treatments given to patients suffering from conditions for which ECT is considered 511W beneficial is about six. I am advised by the Medical Research Council that there is no evidence that ECT given in the proper manner and with proper safeguards does cause irreversible brain damage. There are also good evidence that ECT properly used in selected cases is a most effective form of treatment.
I have not issued any guidance to health authorities.
I would refer my hon. Friend to a leading article in the British Medical Journal of 4th October 1975 discussing this subject.
§ Mr. Christopher Priceasked the Secretary of State for Social Services what guidance she has given to NHS hospitals about obtaining the consent of both voluntary and compulsory patients to ECT and psycho-surgical operations; and in what circumstances these consents have to be given in writing.
§ Dr. OwenNo general guidance on this subject has been issued by the Department, but the advice of the Department's legal advisers, in broadly the following terms, has been given in answer to inquiries
512WNo treatment involving any special risk, however slight, should be administered to an informal patient over 16 years of age who is capable of appreciating and agreeing to what is proposed unless the patient gives his or her specific consent in writing. This would certainly apply where ECT is proposed. In the case of an informal patient over 16 who is incapable of giving an effective consent it seems that no one else can legally give such consent on his behalf.Where treatment is necessary to preserve the life or health, including mental health, of the patient it is thought that the administration of such treatment would be unlikely to be questioned and the more so if the consent of the nearest relative had previously been obtained.In the case of informal patients under the age of 16 the consent of the parent or guardian to treatment would probably be held to be effective in law.In the case of a patient detained for treatment under the Mental Health Act it is thought that any recognised form of treatment considered necessary for the mental disorder from which he is suffering may lawfully be administered irrespective of his wishes or those of his relatives, whose interests may conflict with his. However, in the case of treatment involving any risk it is desirable that the patient, if he is capable of understanding, and the nearest relative should be told what is proposed and the consent of both should if possible be obtained.This whole question of consent to treatment of psychiatric patients is being considered in the light of the recommendations of the Committee on Mentally Abnormal Offenders. I understand that in practice a form of treatment involving any special risk is not administered if the patient or his nearest relative objects. In the case of someone under 16, I would not expect psycho-surgical operations to be carried out other than in very exceptional circumstances, and only then with the support of at least two medical practitioners and after the fullest consultations with other professional disciplines.
§ Mr. Christopher Priceasked the Secretary of State for Social Services if she will list in the Official Report how many electro-convulsive therapy and psycho-surgery operations, respectively, took place on compulsory and voluntary patients, respectively, in NHS hospitals in each of the years between 1965 and 1974 inclusive.
§ Dr. OwenInformation on the number of ECT treatments is not collected centrally. The Hospital In-Patient Enquiry (HIPE) records about 200 leucotomy, lobotomy and tractotomy operations carried out annually from 1969 to 1973. But as HIPE is based on a one in 10 sample of all non-psychiatric discharges and deaths, it will not count any operations performed within a psychiatric unit. As the number of operations is small more detailed information would not be statistically reliable. The figures are likely to include some tractotomies performed in the treatment of Parkinsonism. Information is not available as to whether these operations were performed on compulsory or voluntary patients.
I am considering the case for collecting more precise information on psycho-surgery operations.
§ Mr. Christopher Priceasked the Secretary of State for Social Services what studies she has made into the possible damaging and irreversible side effects of ECT and psycho-surgery operations.
§ Dr. OwenThe Department has not made any studies, but there have been studies by others into both. Biomedical research is the responsibility of the Medical Research Council, which, I understand, is considering further studies 513W of psycho-surgery. I am sending my hon. Friend a copy of one paper on psycho-surgery published in the "Annals of Clinical Research" in 1971.