New guidelines on shock therapy

Friday, May 02, 2003
LONDON
By Health Newswire reporters

Electric shock treatment should only be used when other options have failed and where patients have been involved in the decision, according to new government guidelines.

The National Institute for Clinical Excellence (NICE) says controversial electroconvulsive therapy (ECT) should only be used to achieve a rapid, short-term improvement after other treatment options, such as drug therapy, have failed, or when the patient's condition is considered to be potentially life-threatening.

The guidance also says both the patients and doctors responsible for treatment should be involved in the decision to use ECT. In addition, valid consent must be obtained in cases where a patient has the ability to agree to or refuse treatment.

Such consent must, says the guidance, be obtained without the patient being pressured or coerced. The patient should also be reminded that they are entitled to withdraw consent at any time.

ECT, which has been around since the 1930s, is used to treat people with illnesses such as depression, mania, catatonia, and sometimes schizophrenia. It involves putting electrodes onto a patient's head and delivering a brief electric current to the brain, which causes a seizure.

ECT can have side effects such as short- or long-term memory loss, which some patients find very distressing.

The launch of the guidance coincides with the start of an accreditation programme developed by the Royal College of Psychiatrists research unit. This will ensure that health professionals who use ECT follow NICE guidance and are properly trained.

However, the mental health charity MIND says legislative change is needed to guarantee patients' rights, particularly to refuse ECT.

The charity has expressed concern that ECT is still seen as an effective treatment, especially as a recent survey showed that two-thirds of patients who had undergone ECT said they would not consent to have it again.

MIND also believes that the Mental Health Act should be changed to give people the right to refuse ECT, even if they are compulsorily detained.

Richard Brook, chief executive of MIND said, "The administration of ECT has been stuck in the dark ages for far too long. While MIND continues to question ECT's effectiveness, these guidelines and the Royal College of Psychiatrists' plans for accreditation show a step in the right direction."

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