Electro-convulsive Therapy (Hansard, 15 July 1994)

§ Dr. Godman
To ask the Secretary of State for Scotland for which ailments electro-convulsive therapy is recommended; what guidelines are issued to hospitals and consultant psychiatrists concerning the use of electroconvulsive therapy; and if he will make a statement.

§ Mr. Stewart
[holding answer 13 July 1994]: Electroconvulsive therapy is most commonly used to treat severe intractable depressive illness. It is very occasionally used to treat acute schizophrenia.
ECT is covered by the consent to treatment provisions of the Mental Health (Scotland) Act 1984 and guidance on these requirements is contained in "Notes on the Act", in the "Mental Health (Scotland) Act 1984 Code of Practice", which includes as an annexe guidance produced by the Mental Welfare Commission and in the NHS Executive's booklet "A Guide to Consent to Examination, Investigation, Treatment or Operation".
Guidelines on "The Practical Administration of ECT" were published by the Royal College of Psychiatrists in 1989. The observance of these guidelines is recommended in the training of all doctors administering this form of treatment.

§ Dr. Godman
To ask the Secretary of State for Scotland what records are kept by the Scottish Office concerning the frequency of the employment of electro-convulsive therapy by hospitals and consultant psychiatrists in each of the past 10 years; and if he will make a statement.

§ Mr. Stewart
[holding answer 13 July 1994]: This information is not recorded centrally.

§ Dr. Godman
To ask the Secretary of State for Scotland what advice and guidance is normally given to a psychiatric patient or members or his or her family or others with an interest in his or her welfare concerning to the employment of electro-convulsive therapy and his or her right to refuse electro-convulsive therapy in favour of an alternative form of treatment; and if he will make a statement.

§ Mr. Stewart
[holding answer 13 July 1994]: The principles of the general law of consent to treatment for physical disorders apply to any proposed treatment for a voluntary patient's mental disorder, and the doctor is required to explain to the patient, before he signs a consent form, the nature, purpose and likely effects of the treatment, and why he should consent to it. In the case of electro-convulsive therapy, the explanation given should clearly indicate that the treatment can be refused and that the patient may withdraw his consent at any time, even before the first treatment is given. The doctor should also make himself available to answer any questions that the patient, or their carer, may have about the treatment. A leaflet produced by Royal College of Psychiatrists also provides answers to questions about ECT commonly asked by patients.
833W
The position of detained patients is regulated by part X of the Mental Health (Scotland) Act 1984. In the case of ECT, the Act requires the consent of the patient and the certification by a medical practitioner—either the responsible medical officer or a practitioner appointed by the Mental Welfare Commission—that the patient is capable of understanding its nature, purpose and likely effects and has consented to it; or, alternatively, the certification by a medical practitioner appointed by the Mental Welfare Commission, other than the RMO, that the patient is not so capable but that, having regard to the likelihood of alleviating or preventing a deterioration in the patient's condition, the treatment should be given.
In certain circumstances ECT may be given without consent or a second opinion in cases of urgency, for example where it is immediately necessary to prevent a serious deterioration in the patient's condition, or to alleviate serious suffering or to prevent the patient from being a danger to himself or others.

§ Dr. Godman
To ask the Secretary of State for Scotland what steps he has taken to satisfy himself that those psychiatric patients who have undergone electroconvulsive therapy over the past 20 years have suffered no long-term deleterious effects from such treatment; and if he will make a statement.

§ Mr. Stewart
[holding answer 13 July 1994]Research by Weeks, Freeman and Kendell, 1980, found no long-term deleterious effects from electro-convulsive therapy.
Later research—Freeman and Cheshire, 1986; Benbow, 1988; Malcolm, 1989; and Cheshire, Freeman and Chiswick, 1991—indicated a high level of patient satisfaction with the results of treatment. The Royal College of Psychiatrists also reports that more than eight out of 10 patients respond well to ECT treatment, making it the most effective treatment for severe depression, and that most patients recover their ability to work and lead a productive life after their depression has been treated in this way.
A sub-group of the CRAG/SCOTMEG framework for action working group on mental illness is currently considering ECT and its report in the form of "good practice" guidelines is expected in the autumn.