Warning against overuse of shock therapy: New Zealand

NZPA | Tuesday, 27 November 2007

A committee of MPs says electro-convulsive therapy (ECT) should only be used as a treatment of last resort.

Under ECT, specialised medical equipment is used to induce an epileptic seizure by passing a small electrical current across the brain.

Parliament’s health select committee has been considering a petition by doctor Helen Smith who wants ECT to be voluntary, and its use with children, pregnant women and the elderly either banned or severely restricted.

Dr Smith argued the elderly should be given the opportunity to formally decline ECT prior to becoming elderly or unwell.

She also said there should be stricter regulatory reporting and controls in place for ECT use.

The health select committee, in its report on Dr Smith’s petition, has agreed with her in some areas.

It recommended that ECT “should only be used as a treatment of last resort when all other options have been considered”.

It said the Royal Australian and New Zealand College of Psychiatrists should urgently developing its guidelines into a national professional standard.

The circumstances for a patient to be required to undergo ECT should be more restricted, it said.

The committee also recommended the Mental Health (Compulsory Assessment and Treatment) Act 1992 be amended to ensure ECT was administered only with a patient’s consent where this was possible.

Where this was not possible it should be administered on the basis of a “truly independent second opinion” from certifying clinicians that were not attached to the institution from which the first opinion was obtained.

A majority on the committee recommended ECT be administered to pregnant women with informed consent only in cases of emergency where there was no other option available.

It wanted data on the rate ECT was administered to pregnant women to be collected and reported annually.

It said ECT should only be administered to children and young people “where in the opinion of certifying clinicians there is no other option available”.

The majority of the committee recommended that consideration be given to requiring an order under the Protection of Personal Property Rights Act when ECT was administered to the elderly, because of its presumption of competence and the least restrictive intervention.

The majority on the committee also recommended that where patients had made valid advance directives that they did not wish to undergo ECT, that these directives should be given effect.

ECT is used to treat severe depression and some other mental disorders.

Side effects include headaches, muscle aches or soreness, nausea, confusion and memory loss.

Critics condemn its use but the Ministry of Health says it is a valuable and sometimes life-saving treatment.

The Ministry of Health said 70 to 80 per cent of patients who received ECT responded to it well.

In 2004/05, 307 people received ECT. In the 2003/04 year, 305 received it.

Disproportionately more women than men received ECT and the committee was not given a satisfactory reason why this was the case.

While no statistics were given, the college of psychiatrists said it was rare to treat pregnant women with ECT.

In the 2003/04, 2004/05 and 2005/06 years five, two and one person under the age of 20 received ECT treatment.

The elderly were the main group to receive ECT.

The committee said in its report, tabled in Parliament today, that it was concerned about wide regional variations in its use. Some district health boards were administering as many as 18 treatments as part of a course of ECT, when guidelines stated six to 10 treatments.

“Given it is a controversial treatment, we consider it is essential that ECT be governed by a national standard and not by just guidelines,” the committee said.

The National Party had a minority view included in the committee’s report on the petition.

It felt the use of ECT was “an important life-saving treatment option that must remain available to clinicians”.

It said ECT was already generally a treatment of last resort, and there was “a very real risk of suicide” if the patient were left untreated.

An unpalatable reality in the age of improving care

New Zealand Herald
November 06, 2007
By Chris Barton

It happens more often than you’d think. A person arrives at a mental health unit in a psychotic state and is immediately put into a seclusion room.

Mental health consumer adviser Vicki Burnett tells the story of patient A. “When psychotic, she thought she was on fire and her hands were on fire. Put into a seclusion room, all the walls appeared to her to be on fire. I can’t think of anything worse or more terrifying.”

Why, asks Burnett, when someone is struggling with reality, lock them into a stark empty space with nothing to anchor them to the real world? “That’s not low stimulus, it’s worse than low stimulus because there is nothing – there is no reality.”

The sticking point for this story is getting a photo of a seclusion room. No one is keen to provide an image of this unpalatable reality that harks back to the days of the padded cell. Locking people up in solitary confinement is not a good look for enlightened, recovery-based mental health services in the 21st century.

We can get a description. “A seclusion room is a bare room with a plastic mattress on the floor and a disposable potty that’s made out the same stuff that egg cartons are,” says Burnett.

We know, too, the effect of being put in seclusion. Anne Helm, a member of the Confidential Forum for Former In-Patients of Psychiatric Hospitals, says: “If you are in a seclusion cell you have feelings of worthlessness, of loss of dignity and, at the very time when you are most fragile, you are removed from any human contact. It’s counterproductive to what people generally need.”

For the first time, we also know just how much this outmoded practice is still being used in mental health units around the country today.

Data just made public by the office of the director of mental health shows that 477 people were locked in seclusion rooms during the last quarter of last year. The bulk (383) were in adult mental health units, 59 were in forensic (crime related) services and 18 in child and young persons facilities. Data for those over the age of 65 was incomplete, but it appears most mental health units for the elderly do not have seclusion rooms.

Maori are more often secluded than other ethnic groups, accounting for 186 of the 477 locked up. Most stays (82 per cent) were shorter than one day. The longest recorded was 30 days.

There were 1514 seclusions in adult services during the quarter, indicating the same people are secluded multiple times – about four times on average. There is a wide variation in the data from district health boards (DHB). Tairawhiti (Gisborne), Canterbury and Bay of Plenty had the highest incidence of locking people up, and Auckland, Waitemata and Capital and Coast were among the lowest.

“Seclusion is a worry to us,” says the mental health director for the Ministry of Health, Dr David Chaplow. “We want it to start trending down and we want to really minimise, possibly even extinguish, the use of seclusion.”

The worry for the ministry is unavoidable evidence that the practice has no therapeutic purpose and that its continued use may breach fundamental human rights – and expose mental health services, already tainted by a legacy of inhumane practices, to further compensation claims.

Chaplow says the latest statistics are one of the steps in setting a benchmark for acceptable practice. At present, the use of seclusion is allowed under the Mental Health Act for the “care” or “treatment” of the service user, or protection of other users in the ward. It’s operation is outlined in the ministry’s Restraint Minimisation and Safe Practice Standard (2001), which is about to be updated.

With only three months of reporting, not too much can be read into the wide variation of figures by district. Tairawhiti, for example, which has the highest number of seclusion events (120 for the quarter) is a six-bed unit with two seclusion rooms.

Its statistics have been looked at by the mental health district inspector, who has reported that the use of seclusion in each of the cases was justified.

But Chaplow says that when the full figures for last year come out such discrepancies will be weighed against the wider picture. “If we do have DHBs wildly out of step, we’ll be saying to them they had better have a look at this.”

He points to reasons for the variations, including data being skewed by one or two difficult patients, demographic differences, ward design, staff training and differences in seclusion practices.

“In the past, it would not be uncommon for people to be secluded as a type of punishment. We are rigorously combating that in our training.”

Burnett is not so sure the message is getting through. “I think seclusion rooms are a threat to people and I think they are used as a threat: ‘If you don’t settle down we’ll have to put you into seclusion.”‘

She argues that it’s not necessary to lock someone in a room to reduce stimuli and says the ministry shouldn’t be approving any new buildings that have seclusion rooms.

Although the ministry wants the use of seclusion minimised in mental health services, many – including the Mental Health Foundation, the Mental Health Commission and the Mental Health Advocacy Coalition – want its routine practice eradicated. “We would like to see it become unacceptable as a norm to use seclusion – and if it is used, there has to be a thorough justification and explanation,” says Judi Clements, chief executive of the Mental Health Foundation. Clements says that, aside from seclusion, other statistics in the director’s report raise concerns, such as that 224 patients were treated with electroconvulsive therapy (ECT) last year and that 17 per cent of the treatments given did not have consent.

Seventy per cent of the recipients were women, most aged in the 64 to 84 age age group.

“We need to keep asking, what place does compulsion have in an environment that is moving towards a more enlightened approach towards people with mental illness?” says Clements.

Being forced to accept assessment and intervention against their will is a common complaint among mental health service users, and seclusion – forced restraint and imprisonment – is a prime example.

Psychiatrist David Codyre, also a member of the Mental Health Advocacy Coalition, agrees. He sees no evidence that seclusion is of any benefit and much confirmation from consumers that it is harmful and a significant breach of human rights. “It is no longer sustainable to say this is a necessary evil,” says Codyre. “It’s an unnecessary evil in the vast majority of cases.”

Codyre says studies show that when staff work in ways that minimise confrontation and maximise reassurance and engagement, the need to use seclusion as an intervention reduces dramatically.

Importantly, when staff work to reduce the use of seclusion, the level of violence in in-patient units, and particularly assaults on staff, reduces in a parallel line. “While seclusion was viewed as a way to keep everyone safe, what it actually was doing was increasing levels of trauma and violence for everyone involved .”

Consumer advocate Burnett sees the use of seclusion as poor nursing practice. “In nearly all instances it could have been avoided by better engagement with the person before that was necessary.”

But not everyone is convinced that it’s possible to totally eradicate seclusion. “That’s a good aim to have – whether it’s realistic I’m not entirely sure,” says Nigel Fairley, Capital and Coast DHB director of area mental health services, a DHB which is among the lowest users of seclusion practices. “The problem with that aim is that it does not recognise that, in some circumstances, there is a therapeutic value for the use of seclusion in that it provides the person a low stimulus environment, which is important at that point in time in their mental health issue.” He sees seclusion as a compulsory time out to deal with risky situations – a last, but legitimate, resort.

One who is determined to see seclusion completely removed is Karla Bergquist, the manager of district mental health services for the Waitemata District Health Board.

“We’re supposed to be providing services for people who have experienced trauma that are supportive and caring and therapeutic,” Bergquist says. “I don’t think that seclusion and restraint fit into those categories.”

The DHB has introduced “trauma informed care” projects, where staff use debriefing and analysis of each incidence of restraint and seclusion to understand why they happened and what could be done differently.

Bergquist says studies show that while initially there may be a small increase in the use of psychotropic medication – sometimes called the chemical straitjacket – when seclusion is removed it’s not a lasting effect. “When you’ve had an option that has been available to you for a very long period of time it’s hard to imagine what life would be like without it.” As to staff reaction to her ideas, “A lot of people say ‘You’re off your head’, but we’ve also got a group who are really passionate about moving towards that goal.”

Helm sees seclusion as part of our institutional legacy and no longer appropriate as a response to distress in the light of what is now call recovery-based practice. “It’s basically used as a behavioural management tool in controlling very complex environments.”

Like most, Helm agrees there are instances – such as for those in drug-induced psychosis – when restraint will be required. But seclusion is usually the result of impaired judgment by overworked, over-stressed staffing regimes where room for more appropriate responses is not possible.

“Solitary confinement might be perceived as therapeutic by the staff, when the recipient is seen as calm and contemplative. Mostly, that’s just the trauma of confinement. It breaks the spirit and sometimes results in long held fears which means the service user doesn’t want to use the service again.”

PUNISHED FOR SOMETHING I HAD NO CONTROL OVER
Big guy Mark tells his side of story

Mark, at the time 28, describes his experience of being put into seclusion in an Auckland mental health unit for three days.

I was diagnosed bipolar schizoaffective. At the time I wasn’t aware I had problems. I thought what I was going through was natural – that it was a spiritual awakening when you start hearing voices. I got hospitalised in February 2003. I had no clue about why I was there. I wanted to escape and one night I did. I took off out the door, jumped the fence and was away.

I got caught and put into the acute service. In the ward I was wrestled to the floor and given an injection to calm me down. I was afraid for my life. I thought they were going to do something to me. I spent the next few days locked up in a daze – you don’t know what time it is. All I recall is waking up and going back to sleep again. Sometimes there would be food and water. It was a lock-up room. It felt like being chucked into prison without a conviction – without any reason for why I was there.

I remember the smell of urine. The room wasn’t cleaned often. The walls were yellowish brown. My bed was just a flat pillow on the floor. They would come and give me another injection. There was nothing to look at all day – except out the window in the door which had a view of the corridor. There was no other window. The lights were on 24/7. The only person I saw was the one who brought the tray in and took away the waste. It’s something you shelve – try to forget about. I felt helpless and kept thinking I had done something wrong to be locked up. It felt like I was being punished for something I had no control over.

At the end of it, in the review, the staff told me the main problem was they thought I would be violent and psychotic and basically because I’m a big guy, they thought it was better to keep me monitored. I was in there for three days. My parents cried when they saw me – they thought going to hospital was the only and best choice for me. They didn’t realise anything like this would have occurred.

Little merit in ECT, US study finds

Opponents of electric-shock therapy are calling for a ban on its use in the elderly after a new study shows they are at increased risk of permanent brain damage.

The Press (New Zealand)
Feb 7 2007
By KAMALA HAYMAN

The elderly, women and people with lower IQs are the most vulnerable to brain damage, particularly memory loss, according to the first large-scale study on the long-term effects of electroconvulsive therapy (ECT).

About 300 patients a year are given ECT in New Zealand. Two-thirds are women and about 60 per cent are over the age of 50.

In a report released last year, the Health Ministry said ECT was “a valuable and sometimes life-saving” treatment for depression, mania and catatonia, although its effects were typically short-term.

In the New York study, just published in the Neuropsychopharmacology international journal, researchers followed 347 patients for six months.

The research team, led by Harold Sackeim, said the study provided the evidence that “adverse cognitive effects can persist for an extended period and that they characterise routine treatment with ECT”.

The “more severe and persisting” memory problems were found in those given ECT to both sides of the brain, leading the team to conclude there was “little justification” for such treatment.

Some patients were given ECT to only the right side of the brain, to protect the memory centre in the left.

Auckland clinical psychologist John Read said some New Zealand patients were still being given ECT on both sides of the brain.

Read, a long-standing campaigner against the use of ECT, has sent a second petition to the parliamentary health select committee calling for a ban on the treatment in older people, pregnant women and those under 18.

Read said the beneficial effects of ECT were short-term and there was no evidence it saved lives by preventing suicide.

He said patients given ECT should be told: “It does make some people feel better for a short period of time and it causes permanent brain damage for a significant proportion of people.”

A Christchurch 53-year-old, given ECT for severe depression last year, said she had consented to her 12-dose treatment but did not believe it was informed consent as she was not warned of the risk of permanent memory loss. “I have lost my long-term memory and I have lost totally the ability to administer and organise things,” she said.

Despite the “dreadful” side-effects, the woman, who did not want to be named, said ECT was a valuable treatment. Severe depression was not only life-threatening, it was a horrendous experience. “I was like the walking dead.”

She said her depression returned several months after the ECT, although it had since lifted, possibly due to acupuncture and meditation.

Canterbury psychiatric patients are among the most likely in the country to have ECT. In the year to June 2005, 79 Canterbury patients had a course of ECT, about one-quarter of the 307 treated nationally.

Health select committee chairwoman and Green MP Sue Kedgley said ECT was a “barbaric and old-fashioned technique” used in New Zealand with little regulation, monitoring or evaluation. The number of patients given ECT varied wildly in different parts of the country, as did the length of each course.

Kedgley was concerned that one in five patients had ECT without giving consent, and the rate was above 50% in some districts.

“If it is going to cause the harm that this research shows, then I certainly question why it should be given to people without their consent,” she said.

Canterbury psychiatrist Richard Porter, who oversees ECT use, said one-sided (unilateral) ECT was usually prescribed unless treatment was particularly urgent or there was no response to unilateral ECT.

“The choice is discussed with patients and family and the pros and cons explained before the decision is made,” he said. This particularly applied to the elderly, in whom it had been “known for a long time” that memory loss was more likely, he said.

Electroconvulsive Therapy Causes Permanent Amnesia and Cognitive Deficits

ect.org note: This article is appearing in numerous publications and websites, so to avoid repeating the same information again and again, an ongoing list of publications will be posted below.

———–

Forbes
Electroconvulsive Therapy Causes Permanent Amnesia and Cognitive Deficits, Prominent Researcher Admits
12.21.06, 3:38 PM ET

NEW YORK, Dec. 21 /PRNewswire-USNewswire/ — In a stunning reversal, an article in the journal Neuropsychopharmacology in January 2007 by prominent researcher Harold Sackeim of Columbia University reveals that electroconvulsive therapy (ECT) causes permanent amnesia and permanent deficits in cognitive abilities, which affect individuals’ ability to function.

“[T]his study provides the first evidence in a large, prospective sample that adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings,” the study notes.

For the past 25 years, ECT patients were told by Sackeim, the nation’s top ECT researcher, that the controversial treatment doesn’t cause permanent amnesia and, in fact, improves memory and increases intelligence. Psychologist Sackeim also taught a generation of ECT practitioners that permanent amnesia from ECT is so rare that it could not be studied. He asserted that most people who said the treatment erased years of memory were mentally ill and thus not credible.

The National Institute of Mental Health (NIMH) estimates that more than 3 million people have received ECT over the past generation. “Those patients who reported permanent adverse effects on cognition have now had their experiences validated,” said Linda Andre, head of the Committee for Truth in Psychiatry, a national organization of ECT recipients.

Since the mid-1980s, Sackeim worked as a consultant to the ECT device manufacturer Mecta Corp. He never revealed his financial interest in ECT to NIMH, as required by federal law, and, until 2002, did not reveal it to New York officials as required by state law. Neuropsychopharmacology has endured negative publicity over its failure to disclose financial conflicts of journal authors, resulting in the editor’s resignation and a promise to disclose such conflicts in the future; yet there is no disclosure of Sackeim’s long-term relationship with Mecta, nor did Sackeim disclose his financial conflict when his NIMH grant was renewed to 2009 at approximately $500,000 per year.

The six-month study followed about 250 patients in New York City hospitals, an unusually large number; most ECT studies are based on 20 to 30 patients. Sackeim’s previously published studies were short term, making it impossible to assess long-term effects. “However, in other contexts over the years — court depositions, communications with mental health officials, and grant protocols — Sackeim has claimed to follow up patients for as long as five years. This raises serious questions as to how long he has actually known of the existence and prevalence of permanent amnesia and why it wasn’t revealed until now,” Andre said.

Besides finding that ECT routinely causes substantial and permanent amnesia, the study contradicts Sackeim’s oft-published statements that ECT increases intelligence and that patients who report permanent adverse effects are mentally ill.

“The study is a stunning self-repudiation of a 25-year career,” Andre said.

———————————————————-

Other publications that have picked up the story:

Dec 22 2006:

Forbes
Medical News Today
Brietbart
Dallas News
Kron.com
MedicalDevices.org
TXCN.com – Healthcare & Hospitals
WFAA
Philadelphia Weekly
Genetic Engineering News
Pharma-Lexicon

Electroconvulsive Therapy Causes Permanent Amnesia And Cognitive Deficits, Prominent Researcher Admits

Electroconvulsive Therapy Causes Permanent Amnesia And Cognitive Deficits, Prominent Researcher Admits

Medical News Today
Dec 22 2006

In a stunning reversal, an article in the journal Neuropsychopharmacology in January 2007 by prominent researcher Harold Sackeim of Columbia University reveals that electroconvulsive therapy (ECT) causes permanent amnesia and permanent deficits in cognitive abilities, which affect individuals’ ability to function.

“This study provides the first evidence in a large, prospective sample that adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings,” the study notes.

For the past 25 years, ECT patients were told by Sackeim, the nation’s top ECT researcher, that the controversial treatment doesn’t cause permanent amnesia and, in fact, improves memory and increases intelligence. Psychologist Sackeim also taught a generation of ECT practitioners that permanent amnesia from ECT is so rare that it could not be studied. He asserted that most people who said the treatment erased years of memory were mentally ill and thus not credible.

The National Institute of Mental Health (NIMH) estimates that more than 3 million people have received ECT over the past generation. “Those patients who reported permanent adverse effects on cognition have now had their experiences validated,” said Linda Andre, head of the Committee for Truth in Psychiatry, a national organization of ECT recipients.

Since the mid-1980s, Sackeim worked as a consultant to the ECT device manufacturer Mecta Corp. He never revealed his financial interest in ECT to NIMH, as required by federal law, and, until 2002, did not reveal it to New York officials as required by state law. Neuropsychopharmacology has endured negative publicity over its failure to disclose financial conflicts of journal authors, resulting in the editor’s resignation and a promise to disclose such conflicts in the future; yet there is no disclosure of Sackeim’s long-term relationship with Mecta, nor did Sackeim disclose his financial conflict when his NIMH grant was renewed to 2009 at approximately $500,000 per year.

The six-month study followed about 250 patients in New York City hospitals, an unusually large number; most ECT studies are based on 20 to 30 patients. Sackeim’s previously published studies were short term, making it impossible to assess long-term effects. “However, in other contexts over the years — court depositions, communications with mental health officials, and grant protocols — Sackeim has claimed to follow up patients for as long as five years. This raises serious questions as to how long he has actually known of the existence and prevalence of permanent amnesia and why it wasn’t revealed until now,” Andre said.

Besides finding that ECT routinely causes substantial and permanent amnesia, the study contradicts Sackeim’s oft-published statements that ECT increases intelligence and that patients who report permanent adverse effects are mentally ill.

“The study is a stunning self-repudiation of a 25-year career,” Andre said.

New Zealand: First Report of Director of Mental Health

29 November 2006
Scoop Independent News

First Annual Report of the Office of the Director of Mental Health released
The first annual report by the Office of the Director of Mental Health has been released today by the Ministry of Health.

The publication provides a record of the work the office does and reports on some of the activities of District Inspectors of Mental Health and the Mental Health Review Tribunal. It is part of the office’s accountability to the sector and will be of significant interest to many people, including mental health service users and their families, those who work in the sector, and advocacy groups. It will also contribute to improved standards of care and treatment for people with a mental illness.

“We are proud of this work and believe it is an enormous achievement. The report reflects the importance we place on transparency and accountability to the sector and the wider public. We hope to build on this information in subsequent reports and include trend data,” says Dr David Chaplow, Director of Mental Health and Chief Advisor Mental Health.

The report is divided into three sections. The first section looks at how the office operates and the legislation it is guided by. The second section describes the work carried out by the office in 2005 and the third section provides information on the use of the Mental Health (Compulsory Assessment and Treatment) Act 1992, electroconvulsive therapy treatments and deaths of people subject to the Act. An appendix provides historical background on compulsory treatment in New Zealand.

For the first time raw data on the use of compulsory treatment is being published. It shows marked variations between district health boards.The data has not been analysed and the differences could be due to a range of reasons, such as the differences in the nature of their populations, service coverage or clinical practice.

Information on the numbers and outcomes of Special and Restricted-Patient’s leave and change of legal status applications considered by the Health Minister are also included.

“We have not captured all the data we would like, for example statistics on the use of force, serious adverse incidents and seclusion are not included because the earlier data is not reliable enough,” Dr Chaplow says.

” However, District Health Boards now have more robust reporting procedures in place and as a result we expect to be able to include trend data in future annual reports.”

The report also includes research looking at the outcomes for Special Patients found not guilty of a crime, by reason of insanity, over the last three decades. The work followed an indication by the Law Commission that it intended to review section 23 of the Crimes Act 1961, which relates to insanity.

“Our research found that following discharge in to the community, people acquitted on the grounds of insanity are reconvicted of violent crimes at a very low rate, although readmission to hospital is more common,” Dr Chaplow says.

During 2005 there were 23 deaths recorded for people subject to the Mental Health (Compulsory Assessment and Treatment) Act 1992, of which six were suspected suicides.

Full report

Harold Sackeim reverses position in upcoming study

by Linda Andre
Director, CTIP

The Cognitive Effects of Electroconvulsive Therapy in Community Settings

NIMH-funded research study published in the January 2007 issue of Neuropsychopharmacology

Author and primary investigator: Harold Sackeim

Funding: NIMH grants

#35636, Affective and Cognitive Consequences of ECT, funded since 1981 for a total of approximately ten million dollars so far (grant has been renewed through 2009)

#59069, ECT Practices in Community Settings—Evaluating Outcomes, funded since 1999 for a total of approximately 3.5 million dollars so far

Summary: After 25 years and millions of dollars of federal funding to research the adverse cognitive effects of ECT—25 years in which not one single longterm followup study was ever published—self-proclaimed “world expert” on ECT Harold Sackeim has now reversed his position, admitting that ECT routinely causes permanent memory loss and deficits in cognitive abilities. His new study—the first to be published in which he followed patients as long as six months, and one of his only studies to use controls—validates a generation of patient reports of permanent iatrogenic disability, and disproves Sackeim’s previously published claims that these reports were simply symptoms of mental illness. Other findings: there is no evidence that ECT increases intelligence, as Sackeim has previously claimed; and women are much more likely than men to experience severe permanent amnesia.

Significance: Harold Sackeim has been called the Pope of ECT, and for good reason. He’s published more on ECT than anyone in the world, has received more money to research it than anyone in the world, and is the author of the American Psychiatric Association’s patient information statement and consent forms, which are used by most hospitals in America. Through his writing, teaching, testimony—and positions on peer review, editorial, and funding boards, including NIMH grant review panels—he has more influence on what the profession and the public believe about ECT than anyone in the world. What Harold says goes.

Conclusion: This study could have been done at any point in the past 25 years. If it had, a generation of patients could have been warned of the likelihood of permanent significant memory and cognitive deficits before, instead of finding out after, ECT. In fact, there is evidence—from Harold’s own statements—that over the years he has in fact conducted studies following up ECT patients for a long as five years…but never published the results. Why not? Why did it take 25 years and over ten million dollars to validate what patients have been saying all along? In other words: What did Harold know, when did he know it, and why wasn’t it revealed?

Quotable quote from the study: This study provides the first evidence in a large, prospective sample that the adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings.

For a detailed critique, see below.

For the past 25 years, patients who received electroconvulsive therapy (ECT) have been told by the nation’s top ECT doctor that the controversial treatment doesn’t cause permanent amnesia or cognitive deficits and, in fact, improves memory and increases intelligence. Psychologist Harold Sackeim of Columbia University also taught a generation of ECT practitioners around the world that permanent amnesia is so rare it could never be studied. Sackeim was the popularizer if not originator of the position that former patients who said the treatment erased memory were simply mentally ill and thus not credible.

His newest and perhaps last ECT research study disproves his tenaciously held claims about the treatment’s harmlessness. It is, in effect a stunning self-repudiation of a 25-year research career…one in which he accepted federal research money with one hand and consulting fees from shock machine companies with the other.

See, for instance, the key finding:

This study provides the first evidence in a large, prospective sample that the adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings.

Similarly, from the abstract:

Despite ongoing controversy, there has never been a large scale, prospective study of the cognitive effects of electroconvulsive therapy

Sounds like the research team is congratulating itself for being “the first,” as if they’d made a discovery before anyone else, doesn’t it? You might think that…if you didn’t know that Sackeim has held the only available NIMH research grant to study ECT’s adverse effects, titled “Affective and Cognitive Consequences of ECT,” continuously since 1981…and if you didn’t know what Sackeim promised the federal government in his original application for grant funding:

“The major objective of the proposed research is to examine the effects of bilateral and right unilateral electroconvulsive therapy on affective and cognitive functioning. The consequences of the two treatment modes will be studied in regard to neuropsychological functions that have previously not been studied…Drug-free inpatients presenting major unipolar depressive disorder will be tested before, during and after treatment and a matched normal control group will be tested at comparably spaced times.”

Instead of doing this, however, he used his grant money largely to compare different types of ECT to each other, not to examine the effects of ECT; and only less than a handful of his 200+ published studies used normal controls, an absolute necessity to isolate the effects of ECT.

Why did it take 25 years to conduct one large, long-term controlled follow-up study? And in the absence on this research, why did Harold so confidently assure professionals, patients, legislators, and the public that ECT was safe?

A closer look at the study shows us that, in fact, Harold and his team are still not being honest with us, still not revealing all they know. They tried their damnedest not to find out what ECT really does…but failed. Here they reveal only the minimum information they had to concede after using every trick in the book to bias their research in favor of not finding negative effects of ECT.

What tricks did they use here?

1) The assumption that ECT does not cause permanent amnesia and cognitive deficits was built into the design of the study. How so? The study allowed subjects who’d had ECT before, as recently as two months prior, to be counted as the “before ECT” patients–meaning before this course of ECT. It assumed that any effects of ECT resolve within two months. 43% of the subjects had had prior ECT, so that at least half of the data involved comparing the effects of ECT to the effects of more ECT–not isolating the effects of ECT.

2) The outcome measures used to measure amnesia and cognitive function are irrelevant and inadequate to measure the known effects of ECT. Yet even deliberately using measures that would result in underestimating deficits, these deficits were still found to be profound and persistent!

For a critique of the tests used by Sackeim, see Robertson and Pryor’s article, Memory and cognitive effects of ECT: informing and assessing patients, in Advances in Psychiatric Treatment (2006), vol. 12, p. 228-238. For example, the Mini Mental Status exam used by Sackeim is a test that screens for dementia, the grossest and most glaring form of cognitive disability, and is useless for detecting the kinds of deficits caused by ECT.

Sackeim uses a memory test he invented himself, the Autobiographical Memory Inventory. This test is unpublished, not publicly available, not validated, and is not used except by ECT advocates. Robertson and Pryor note that the majority of questions are not relevant to the types of information forgotten by ECT survivors, nor can the test detect amnesia beyond a one-year period. A string of references in Sackeim’s new article attempt to provide support for the claim that the AMI “has shown strong reliability and validity as a measure of retrograde amnesia.” Not only do they not show this, but all the referenced articles were written by Sackeim himself!

3) Patient IQs were estimated pre-ECT using a method that underestimates intellectual ability especially with much higher than average IQs; no attempt was made to ascertain actual IQ. No one looked at these patients’ IQs post-shock to see what happened to them; why not?

Sackeim et al. conclude, based on inaccurate assumptions and no data from these or any other patients, that “Individuals with greater premorbid abilities can better compensate for the impact of ECT on cognitive functions” (references claiming to support this point have nothing to do with ECT but are articles about an unproven theory of “cognitive reserve”).

Even if the researchers didn’t choose to seek out survivors of ECT who once had very high IQs, or to respond to the many survivors of formerly superior IQs who have contacted them, there is a substantial record of accounts by persons who had extremely high or genius IQs who have spoken and written publicly of the devastating effects of having those IQs lowered by ECT (Jonathan Cott, Linda Andre, Anne Donahue, and Marilyn Rice are four such individuals.) None of these accounts suggests that people with “greater premorbid abilities” have an easier time after ECT; in fact, they strongly suggest the opposite.

In addition to these tricks, the researchers used one of the most reliable methods of biasing results: concealing data.

1) “A substantial number of secondary cognitive measures” are said to have been administered along with the named tests, yet the researchers nowhere reveal what they were and what the results were.

2) The names of the seven facilities in the New York City metropolitan area are not revealed. While this isn’t necessary for evaluating the results of the study, it means the facilities with the worst outcomes can’t be held publicly accountable, nor can the millions of city residents protect themselves from the worst offenders.

3) The results of the cognitive tests on the 24 control subjects are not revealed, nor is how they compared to the people who had ECT.

It’s a very big deal for the Sackeim team to use matched normal controls; in 25 years and hundreds of studies they have not done so. Normal controls are essential to ethical and valid research. This article states that “The comparison sample completed the same neuropsychological battery at time points corresponding to the assessment period in patients.” But you search in vain to find out how the controls did on the five named tests of memory and cognitive functioning and the unnamed “secondary measures”, and how they compared to the ECT patients immediately and six months after ECT. It’s not in the text, and it’s not in the tables. So why have the controls take the tests at all, if you’re not going to reveal the results?

Only one thing is revealed: The normal controls did much better than the bilateral ECT patients on the (flawed) measure of amnesia:

“The average decrement in AMI-SF scores in patients treated exclusively with BL ECT was 3.4 and 2.8 times the amount of forgetting seen in the healthy comparison groups at the post-ECT and 6-month time periods, respectively, suggesting that the deficits were substantial.”

4) Sackeim does not reveal—has never revealed in hundreds of published articles—his financial ties to the shock machine companies Mecta and Somatics. Yet in sworn testimony, Sackeim admits he has worked for Mecta for at least twenty years. He designs their shock machines for them. Not only is disclosure required by journals such as Neuropsychopharmacology (ironically, the subject of a recent scandal in which authors and even the journal’s editor did not reveal their ties to another company which has hired Sackeim, Cyberonics), it is also required by state law (because Sackeim is an employee of New York State) and federal law (because Sackeim accepts NIMH money).
Sackeim flaunts these laws by not disclosing the money he makes from the shock machine manufacturers.

This article is a damning critique of work done over 25 years (and at the expense of millions of taxpayer dollars) by this very team of researchers.

If you know that Sackeim’s been funded for decades to do this research and chose not to do it, the following statements read very differently than the researchers intended. Instead of self-congratulation, they read as condemnation.

“Empirical information about ECT’s long-term effects derives mainly from small sample studies conducted in research settings, with follow-up intervals limited to two months or less…These studies could not adequately assess the severity and persistence of long-term deficits.”

The use of small samples and short-term follow-up characterizes all of Sackeim’s work until now, and was their choice, deliberately made so as not to know (officially) about “the severity and persistence of long-term deficits.” These researchers single-handedly had the wherewithal to address these belatedly-acknowledged flaws in their own research at any time since 1981.

“We conducted the first large-scale, prospective study of cognitive outcomes following ECT.”

Why the first study only after 25 years? What of the generation of patients—two and a half million people according to their own estimate—who have received shock in those years without knowing the long-term consequences?

“Severity of depressive symptoms showed little relationship with the cognitive measures. At the post-ECT time point, none of the 11 measures were related to concurrent HRSD scores. Findings were also negative for 8 of the 11 measures at the six-month follow-up.”

Translation: patients aren’t just imagining or lying about their cognitive and memory deficits because they’re crazy. Yet in many published articles written on the NIMH dime, and over and over in public testimony and in court, that is exactly what Sackeim and Prudic have claimed. And they have influenced countless others to believe it.

DAMNING FINDING #1: amnesia is substantial and permanent

“The average decrement in AMI-SF scores in patients treated exclusively with BL ECT was 3.4 and 2.8 times the amount of forgetting seen in the healthy comparison groups at the post-ECT and 6-month time periods, respectively, suggesting that the deficits were substantial.”

“At the six-month time point, there continued to be a significant relationship between the number of BL ECT treatments and the extent of retrograde amnesia.”

“Greater amnesia for autobiographical events was significantly correlated with the number of ECT treatments received 6 months earlier.”

DAMNING FINDING #2: cognitive deficits are substantial and permanent

“Compared to baseline performance, at the postECT time point the total patient sample showed deficits in the mMMS, sensitivity of the CPT, delayed recall of the BSRT, delayed reproduction on the CFT…” (All are measures of memory and cognitive ability).

“This study provides the first evidence in a large, prospective sample that the adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings.”

DAMNING FINDING #3: ECT permanently affects reaction time

“Although psychomotor function is of practical importance with respect to driving and other motor activities, the impact of ECT on this domain has rarely been examined…”

(Once again: Whose fault is that?)

“The fact that relative reaction time deficits were observed at the 6-month follow-up indicates a persistent change in the speed of information processing, motor initiation, or response levels…The findings here raise the concern that this form of stimulation has deleterious long-term effects of elemental aspects of motor performance or information processing.”

DAMNING FINDING #4: Bilateral ECT is no good

“For decades, BL ECT represented the gold standard with respect to ECT efficacy…A majority (of US ECT practitioners) administer mainly or exclusively BL ECT…
There appears to be little justification for the continued first-line use of BL ECT in the treatment of major depression.”

(More than 90% of the ECT given in the U.S., and at least as high a proportion in other countries, is bilateral.)

DAMNING FINDING #5 They lied when they wrote in the APA consent form that ECT improves your memory

What this team has said in numerous published articles—and what Sackeim wrote into the American Psychiatric Association guidelines on ECT, the “bible” used by all rank and file shock doctors—that ECT improves memory and intelligence, is not true.

“It is noteworthy that most cognitive parameters were substantially improved at 6-month follow-up relative to pre-ECT baseline, presumably because of the negative impact of the depressed state on baseline performance…It cannot be concluded, however, that the extent of improvement in any group returned to premorbid levels.”

DAMNING FINDING #6: A much greater percentage of women than men are damaged by ECT than men: 81% vs. 18%.

“There was a gender difference, with a greater preponderance of women (81.6%) compared to men (18.4%) in the persistent deficit group.”

No doubt Sackeim and his handlers will try to “spin” this study as a scientific breakthrough, and hold him up as a reformer and patient advocate. Nothing could be farther from the truth.

Where is the apology to the generation of people who were lied to, who will never regain their memories and their cognitive abilities?

Full study

Psychiatrist defends electric shock treatment in NSW

ABC News (Australia)
Nov 18 2006

The chief psychiatrist in New South Wales has defended the use of electric shock therapy in the state’s hospitals.

Government figures show the use of electric shock therapy has doubled in NSW in the past decade and more than a dozen children under the age of 14 have been given the treatment.

But Associate Professor John Basson says the perceived increase is not accurate because records of electric shock therapy were not reliable a decade ago and did not reflect the true number of cases.

He says there is no recorded cases of children receiving the treatment in the past two years, but his colleagues would not support a ban on the practice.

“Across the board they wouldn’t wish to lose it as a possible treatment in very, very rare and unusual cases where the life of the child was put at risk,” he said.

“This would be a treatment of extremely last resort.

“Recently we’ve been very much more scrupulous and that plays a part.

“You’ve got to be careful that we’re not comparing apples with oranges. We’ve got to compare apples with apples and we are now in a situation where we can compare.

“I don’t see that sort of increase that would cause us concern or would cause us to question.”

Australia: Use of electric shock therapy has doubled in decade

By Clare Masters

November 18, 2006
The Daily Telegraph

CONTROVERSIAL electric shock treatment is making a comeback in NSW hospitals, with new figures showing the use has doubled in the past 10 years, including on schoolchildren.

Federal Government statistics show the use of Electro Convulsive Therapy (ECT) – electric shock delivered to the brain – has risen in the state from 2093 in 1994-1995 to 5291 in 2005-2006.

The Medicare statistics recorded 16 cases in the five to 14 age bracket.

The figures come as the Western Australian Government bans ECT for children under the age of 12, but the NSW Government has ruled out prohibiting the treatment for children.

“NSW Health is not aware of any child under 12 years having received ECT in the public hospital system in recent years,” a spokeswoman said.

The Royal Australian and New Zealand College of Psychiatrists Dr Phil Brock said the college did not recommend the use of ECT on children due to their developing brains.

Sydney University’s Professor of Child and Adolescent Psychiatry Garry Walter said he was unaware of any cases in NSW relating to very young children but said it was possible in 15 year olds.

“It is rare but when it is used it can be lifesaving – its use is most common in young people with severe mood disorders,” he said.

Notorious for its barbaric use in Sydney’s Chelmsford Private Psychiatric Hospital, shut down nearly 30 years ago, ECT is increasingly used across the country – up from 9034 in 1994-1995 to 18,083 in 2005-2006.

Although doctors are still mystified as to how the therapy works, it is used to treat mental disorders such as depression and psychosis.

Adverse reports of ECT include memory loss, spontaneous seizures and headaches and modern treatment involves administering, under anaesthetic, a series of electric shocks to the brain at intervals over a few weeks.

Reports on Australian mental health support website depression.com.au record one person claiming the treatment was “humane” and “changed my life”.

Another 54-year-old male said he suffered short-term memory loss and headaches and a 43-year-old male reported forgetting his phone number.

“I will never voluntarily have ECT again,” he wrote.

Fears for dozens of patients given electric shock therapy against their will

The Scotsman
Oct. 8, 2006
KATE FOSTER CHIEF REPORTER (kfoster@scotlandonsunday.com)

DOZENS of psychiatric patients were given electric shock treatment without their consent in Scottish hospitals last year despite huge controversy over the safety of the treatment.

Almost 10% of patients given electro-convulsive therapy (ECT) underwent the procedure as a compulsory treatment for severe depression, according to figures seen by Scotland on Sunday.

Last night doctors revealed some patients are forcibly held down and anaesthetised for the procedure, prompting grave concerns from mental health campaigners who warn that its side-effects include confusion, headaches and long-term memory loss.

But psychiatrists insist ECT can help some patients with severe depression for whom medication is not working.

An audit of Scottish hospitals in 2005 by the Scottish ECT Accreditation Network reveals 433 patients underwent the treatment. A total of 38 had it without giving their consent. Last night, Donny Lyons, director of the Mental Welfare Commission for Scotland, said he believed it was right to treat people against their will if experts agreed ECT was the best option.

He said: “It is done sensitively and we have to be clear why we think a patient needs it. Any force should be kept to a minimum. Using force is extremely unpleasant and rare. You may get people resisting or objecting. Sometimes some general restraint is required.

“ECT is a good thing because it works in people with severe depression; 70% of people will get very significantly better. The more severe the depression, the better it works. It does work very well and it is a good treatment but it does have its risks and can cause memory difficulties.”

New safeguards on ECT were included in Scotland’s new Mental Health Act, which came into force last October. According to the new law, patients cannot be given the treatment forcibly unless they are deemed too mentally ill to be able to make an informed decision. Yet Lyons said it is too early to say whether the new laws are having any effect on the number of people treated forcibly. ECT involves placing electrodes on the temples, on one or both sides of the patient’s head, and delivering a small electrical current. Patients are treated with short-acting anaesthetics and muscle relaxants.

The current produces a seizure lasting up to a minute and can provide short-term relief from severe depression.

According to the audit, the highest rates of ECT were in Grampian, with 93 patients, and Lothian with 61 patients.

Moira Fraser, head of policy at the Mental Health Foundation urged extreme caution over the treatment because of its effects on the memory.

She said: “ECT is very controversial. The impact varies from individual to individual, so you have to be very cautious. If someone is capable of understanding the decision they are making and they have said no, for example because of the long-term memory problems, then it is only in very rare circumstances that it should be given.”

Sandra McDougall, influence and change manager at the Scottish Association for Mental Health, said: “It’s absolutely vital that people thinking about having the treatment are able to access good quality information about potential benefits and risks so that they can make an informed choice about whether to go ahead with it.

“It’s only possible for someone to be given ECT without their consent where they’ve been assessed as not having the capacity to make a treatment decision, and are being treated under relevant legislation.”

Thousands get controversial shock therapy

Sarah Hall
Oct. 4, 2006
Norwich Evening News 24

Health bosses have come under fire today after it was revealed that almost 3,000 patients have been given electric shock therapy in the past three years to treat depression and other mental health problems.

Campaigners have called electro-convulsive therapy (ECT), barbaric and claimed patients’ lives were being ruined.

Figures obtained from the West Norfolk Primary Care Trust and the Norfolk and Waveney Mental Health Partnership NHS Trust under the Freedom of Information Act showed there were 2,837 administrations in Norfolk since 2002. ECT is banned in countries including Holland and Italy.

Chris Wrapson, spokesman for the Citizens’ Commission on Human Rights (CCHR), founded by the Church of Scientology in 1969, said: “ECT is a violation of human rights. It is torturous and barbaric with horrendous side effects. There are nearly 3,000 cases of therapy in Norfolk and this is not acceptable.”

According to the CCHR, ECT involves:

A person being given powerful drugs;

A current reaching up to 500 volts sent through a pad on the head;

This often leads to a patient having a seizure or blacking out.

A Royal College of Psychiatrists survey conducted on psychiatrists, psychotherapists and general practitioners, confirmed memory loss was a side effect of ECT. Of the 1,344 psychiatrists surveyed, 21pc referred to “long-term side effects and risks of brain damage, memory loss and intellectual impairment”. General practitioners reported that 34pc of patients seen in the months after receiving ECT “were poor or worse”.

Dr Hadrian Ball, the Norfolk and Waveney Mental Health Trust’s medical director, said: “Electroconvulsive therapy (ECT) is a well-recognised and effective treatment for some forms of serious mental illness, most usually severe depression.

“The use of ECT is determined by strict guidelines that have been set out by the National Institute for Clinical Excellence and by the Royal College of Psychiatrists. ECT is only used within the trust in complete accordance with these national guidelines and with the law. When psychiatrists make decisions as to whether ECT is required, this is done on the basis of a full assessment of the potential risks and potential benefits to – and the views of – the individual service user.”

What is ECT?

Introduced in the 1930s as a treatment for schizophrenia, electrotherapy was found to cause changes in depressive disorders.

Medical experts say it is a rapid and effective treatment for severe depressive disorders.

Its main benefits come from its efficacy and speed and it is said to be beneficial where there is a high risk of suicide or danger to health because the patient is not eating or drinking enough.

In severe postpartum depression, it may help with the early development of the bond between mother and child.

The effectiveness of ECT depends upon the induction of a convulsion thorough an electric shock. Two important factors in ECT are the amount by which the electrical dose exceeds the seizure threshold of the patient; and where the electrodes are placed on the body.

Adverse effects include confusion, nausea and vertigo. People may also suffer muscle pain in their jaw. There have been reports of seizures for months after ECT. People’s teeth, tongue or lips may be damaged if a gag is not positioned properly and small electrical burns can occur if electrodes are not properly applied.

Anyone with information on adverse reactions to psychiatric drugs is asked to contact the CCHR on 0845 260 2247.

Do you have a mental health story for the Evening News? Contact Sarah Hall on 01603 772426 or e-mail sarah.hall2@archant.co.uk

Electric shock therapy outrage

Worcester News
Sept. 14, 2006

MENTAL health care patients in Worcestershire are given nearly 700 electric shock treatments a year, new figures have revealed.

According to the statistics, the controversial electroconvulsive therapy has been administered 3,400 times in Worcestershire since 2001 – more than any of the 27 health trusts nationwide that have provided figures apart from Leicestershire.

The therapy involves electrodes being attached to the head and an electric current being passed briefly though the electrodes to the brain, causing a seizure.

Surveys by the medical profession have highlighted serious long-term side-effects of the treatment – including brain damage, memory loss and intellectual impairment, while human rights campaigners have branded it “cruel and barbaric” and say it should only be given as a last resort.

But mental health care bosses say the figure equates to just 125 patients treated per year from a Worcestershire population of half a million.

The figures were obtained from the Worcestershire Mental Health Partnership NHS Trust by the Citizens Commission On Human Rights (CCHR) under the Freedom Of Information Act. Commission spokesman Chris Wrapson described them as “extraordinary”.

He said: “Psychiatrists cloak shock treatment in medical legitimacy, the effects of which are horrific, and the full ramifications are not explained to the patients or families, The brutality of ECT shows psychiatry has not advanced beyond the cruelty and barbarism of its earliest treatment.”

A survey by the Royal College of Psychiatrists proved patients treated with electric shock therapy can suffer memory loss as a result.

Of the 1,344 psychiatrists surveyed, 21 per cent referred to long-term side from page one effects and risks of brain damage, memory loss and intellectual impairment.

GPs reported that 34 per cent of patients seen in the months after receiving electroconvulsive therapy were poor or worse.

But a spokesman for Worcestershire Mental Health Partnership NHS Trust said: “The figure quoted by the Citizens Commission on Human Rights of 3,400 relates to approximately 680 administrations per year.

“Most administrations would have been given in batches of six per course of treatment, therefore, the figures relate to approximately 125 people being treated per year from a population of 542,107 in 2001 and a population of 555,832 in 2005.

“Each community mental health team has a caseload of 300 to 500 people at any time. Across the whole county that would be a figure in excess of 10,000 people being seen during that year, therefore, this equates to approximately one per cent or less of the people being treated.”

She added that the trust ensures that the therapy is carried out in accordance with the National Institute for Clinical Excellence guidance.

ECT in Sweden doubles in last five years

Shock rise in electric treatment

Published: 21st August 2006
The Local

The use of electric shocks in psychiatric treatment has more than doubled in the last five years in Sweden.

In 2000 around 18,000 electric shock treatments were administered in Sweden, according to statistics presented by Swedish Radio. Five years later that figure is 40,000.

Electric shock therapy began to be used during the 1930s. Today the method is used primarily on patients who are psychotic, or suffering from deep depression and abnormal mood swings, and when medicine or therapy have failed to have any effect.

Håkan Odeberg, a psychiatric consultant at the Karolinska University Hospital in Huddinge, supports the method.

“In cases where the patient is severely depressed and you have already tried many other forms of treatment, electric shock therapy can have an almost miraculous effect,” he told Svenska Dagbladet.

However, Kjell Broström from the National Association for Social and Mental Health, is not convinced. He told SvD that some patients experience terrible memory loss and that the treatment’s effects can be short-lived.

Shock treatment statistic ‘barbaric’ – New Zealand

19 August 2006
By GEOFF TAYLOR
stuff.co.nz

An opponent wants to stop shock treatment for the mentally ill, but medical experts believe it has positive results. Geoff Taylor reports.

More than one in four people at Waikato Hospital who get electric shock treatment do not consent.

One opponent calls the statistic barbaric, but medical staff say her views are based on out-dated ideas of the treatment.

They say electro-convulsive therapy (ECT) is performed under general anaesthetic and allows many mentally ill people to live normal lives.

Hamilton patients rights advocate Anna de Jonge wants all ECT stopped.

Health Ministry statistics show that in the 2004-05 year 93 non-consented treatments were given to patients at Waikato Hospital. This amounted to 30 per cent of all treatments.

Nationally, 23 per cent of the 307 patients who received ECT did not give their consent.

Waikato Hospital staff said that in the year to March 2006, 23 patients received treatment, six of whom did not give consent.

Anna de Jonge called it barbaric slaughterhouse treatment.

“Treatment without consent is assault,” she said.

“You can’t just grab somebody and shock them. Because it’s done in secret behind closed doors that doesn’t make it okay.”

Waikato Hospital consultant psychiatrist John Strachan said the treatment was used for depression when anti-depressants failed or for people who were psychotic or suicidal.

Patients were deemed not competent to give consent if they lacked the ability to understand information, process it rationally and communicate a choice. At this point, a second opinion was needed from another psychiatrist before treatment could start.

No one was ever forcibly held down and given the treatment. Unlike in the 1950s, patients were fully anaesthetised and had muscle relaxants.

Waikato Hospital general manger mental health Chris Harris said Ms de Jonge’s views were based on perceptions of what occurred about 50 years ago. He said it would be wrong to remove ECT as an option. For a number of people it had been a positive, life-changing experience.

Hamilton woman Margaret Parry, who received treatments in the 1950s, disputed that the treatment was better now.

“I think it’s the worst thing you can do to another human being.”

ECT works in the same way as anti-depressants, affecting the messages sent by neurotransmitters in the brain.

New Zealand ECT rates cause concern

Rotorua electric shock capital

August 17, 2006
The Daily Post
New Zealand

By REBECCA DEVINE Mental health patients in Rotorua and Taupo are three times more likely to get shock treatment than anywhere else in the country.

Latest figures show the area is the shock capital of New Zealand with Lakes District Health Board notching up the highest rate of people receiving electroconvulsive therapy (ECT), or shock treatment.

The figures have prompted at least one psychologist to call for the health board to launch an urgent inquiry.

The rate of treatment for the Lakes area in the 2004/05 year was 22 per 100,000 people – three times the national average of 7.5 people per 100,000.

ECT involves passing an electric current through the brain to induce a seizure, altering brain chemistry to regulate a patient’s mood.

Advocates for the procedure say it is one of the most effective ways to treat depressed patients who don’t respond to other forms of treatment.

However, those against it say it is primitive, causes long-term brain damage and should be banned.

The Lakes District Health Board also had the highest percentage of patients over 20 who were seen by a mental health service and went on to receive ECT. Nationally just 0.4 per cent of people seen by mental health services get the treatment but Rotorua’s rate is more than 1.1 per cent.

Five per cent of those who received the treatment in the Lakes area were given it without their consent under the Mental Health Act.

A statement from Lakes District Health Board communications officer Sue Wilkie said the board was “looking at the figures quoted in the report and carrying out some analysis around that information”.

“Until such time as that work is complete, it would be inappropriate for the DHB to make any further comment,” the statement said.

The report released by the Ministry of Health does not explain why the rate is so high in the Lakes region. However, it says regions with smaller populations are more likely to have fluctuations from year to year and some areas have better access to the service.

Dr John Read, a senior psychology lecturer at Auckland University, said its use had generally either stabilised or declined so it was troubling the Lakes figures had increased.

There was certainly no evidence there were three times as many seriously depressed people in the area, so the only explanation had to be that it was simply being used more often, he said. Dr Read described the treatment as an overly medical approach and there were better ways to treat depression, like looking at the causes.

He said women between 60 and 70 were common recipients of the treatment because they were prone to depression.

“Why is that? The best predictions are loneliness and poverty. How is electricity going to solve that?”

But the country’s top psychiatrist has said Lakes’ figures are still low on an international scale.

Health Ministry mental health chief adviser David Chaplow, who was in Rotorua yesterday, said he was happy with the figures. While he would look at any investigation carried out, Dr Chaplow said the jump certainly wouldn’t prompt the ministry to order such an investigation.

Dr Chaplow said because Lakes was a tiny health board in terms of population the results could be easily skewed. The increase could be caused by more people being seen for depression or psychiatrists who are happier using the treatment, Dr Chaplow said.

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