From The Big Issue in the North
Issue No. 211 May 25-31, 2001

Exclusive by Jane Cassidy

One in four psychiatrists using controversial Electro-Convulsive Therapy in the North of England has experienced patients dying or becoming dangerously ill after treatment, according to a newly-published survey casting fresh doubt on the safety of ECT.

Of 122 consultant psychiatrist staff in the north-west hospitals which responded to the survey, 25 percent reported a death or major medical complications during ECT, which involves firing an electric current through the brain under general anaesthetic to treat severe depression, mania and schizophrenia.

Nine percent had personal experience of a defibrillator being used to try to restart the patient's heart. Only three percent had seen this save the patient's life.

The study, by three psychiatrists based in Manchester, Oldham and Preston, was carried out four years ago, but only published in this month's PSYCHIATRIC BULLETIN, the professional journal of the Royal College of Psychiatry.

It also found that over half of the psychiatrists surveyed would not rule out ECT even if patients were known to be pregnant, or had had a heart attack, within the past three or six months, or had a history of heart attack, hypertension, angina or were fitted with a cardiac pacemaker. When it came to treating patients of over 80 or 90 years old, more than half the doctors thought their ages irrelevant.

Dr. Susan Benbow, an author of the study and member of the Royal College's special committee on ECT, said the 25 percent figure seemed alarming, but was a difficult to analyze because those surveyed were talking about `life-time' experiences which could span 20 years or more.

``You have to balance risks and benefits. If somebody is in a depressive stupor, is also at risk of a medical complication but liable to go downhill fairly rapidly and die without treatment, then it might be safer to give ECT rather than to wait.''

The Royal College is currently revising its 1995 guidelines on the use of ECT, amid growing concern over its ability to regulate the treatment.

Three critical surveys commissioned by the College over the past 17 years have failed to produce improvements, prompting the authors of the latest survey to recommend that the UK follow the US in forcing psychiatrists to receive special training before carrying out the treatment.

Disturbing results of the latest research, leaked to THE BIG ISSUE a year ago and officially published last month, found that only a third of 220 English and Welsh ECT clinics met College standards. Untrained and unsupervised doctors were found out carrying out treatments, outdated machines were being used, And 13 percent of patients were having ECT against their will.

Patients' records were inadequate, only one-third of clinic consultants had read the latest College ECT Handbook, and two thirds of senior nurses in ECT clinics did not even know the handbook existed.

It concludes: ``Twenty years of activity by the Royal College of Psychiatrists and three large-scale audits have been associated with only modest improvement in local practice.''

The damning report prompted College president Dr. Robert Kendall to concede to THE BIG ISSUE last April: ``We're a bit fed up with the slow improvement; we thought the time had come to wheel out the big guns.''

The College, which is powerless to close substandard units, threatened to strip offenders of their prestigious training status. But THE BIG ISSUE believes this threat was carried out at only one unit, which had its status restored after the head of department changed.

Dr. Kendall, an advocate of ECT, who believes many studies, including some undertaken by him, have failed to find lasting ill effects of the treatment, declined to comment further this week.

But mental health rights campaigner Alex Doherty, whose brother Joseph committed suicide following ECT, demanded urgent Government action. ``This situation would never have been allowed to happen in any other field of medicine, and it seems to me the Royal College has completely lost it with regards to enforcing standards on a membership who cannot even be bothered to read their own organization's guidelines.'' he said.