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.”

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