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Wednesday, December 11, 2002
Health-News.co.uk
LONDON
By Vivienne Russell
Mental health campaigners have welcomed provisional suggestions from government advisors on the use of electroconvulsive therapy (ECT), but say further changes are needed to strengthen patient rights.
The National Institute for Clinical Excellence (NICE) has published its final appraisal document on the use of ECT, which says doctors can use the treatment on individuals with severe depressive illness, catatonia or a prolonged severe manic episode.
However, NICE says the treatment should only be used to achieve rapid and short-term improvement of severe symptoms after other treatments options have proved ineffective.
The document says valid consent should be obtained in all cases where the individual has the ability to make the decision, and the choice to use the treatment should be made jointly by the clinician and patient based on an informed discussion.
During ECT, an electric current is passed through the brain in order to induce a seizure. It can increase the risk of a cardiovascular event in at-risk individuals and may lead to short-term or long-term memory loss. Although efforts have been made to standardise the use of ECT, with both the Royal College of Psychiatrists and the Royal College of Nursing publishing guidelines, there is still variation in the use and practice of the procedure throughout England and Wales.
The mental health charity Mind said it was pleased to see that the NICE guidance recognised the risk of side effects from ECT and recommended restrictions on its use. The charity agreed that steps should be taken to ensure that people were not pressured or coerced into accepting the therapy.
But the charity said it was concerned that ECT was still seen as an effective treatment. According to a recent Mind survey, two-thirds of patients who had received the therapy said they would not agree to have it again. The survey also revealed that 73 per cent of recipients were not informed of possible side effects.
Mind Chief Executive Richard Brook said NICE had missed an opportunity to allow people to refuse ECT when they are opposed to it.
But he added, "Though Mind continues to question ECT's effectiveness, these guidelines show a step in the right direction. However, revisions to the current Mental Health Act are essential in order to provide a legal framework in which they can be enforced."
Mind's view was echoed by the mental health charity MACA, which said the NICE guidance was a positive first step, but that the rights of the patients needed to be safeguarded.
Simon Lawton-Smith, head of public affairs at MACA, said, "Health professionals must obtain fully informed consent from patients where possible, and take into account any advance directive. They must also be properly trained to use ECT equipment.
"This all sounds obvious, but it needs the authority of NICE to ensure improvements are made on the ground," he said.
The groups involved in the consultation process that led to the new guidelines have until December 23 to decide whether they wish to appeal against the final appraisal document.