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.