Leaked document reveals electric shock therapy failures

Exclusive by David Milne
The Big Issue (Scotland)

Leaked documents in the possession of The Big Issue in Scotland reveal damning evidence of the misuse of electric shock therapy in Scottish mental hospitals.

And The Big Issue has discovered that an explosive report on the controversial electroconvulsive therapy (ECT) has been repeatedly suppressed by the Scottish Office.

But now a Scottish ECT campaigner and the doctor who led the report team have vowed to go public with its contents if it is not published immediately after the general election.

The report, compiled by the Clinical Research and Audit Group (CRAG), reveals that:
  • few ECT clinics have the correct medical equipment to effectively administer shock therapy, with over 20 per cent using obsolete and dangerous machines.
  • more than a fifth of clinics were judged of an 'unacceptably low standard'
  • almost 75 per cent of clinics kept no proper details of the number and nature of the shock treatments administered.
  • and a staggering 84 per cent of hospital consultants did not set aside time for administering or supervising the treatment, often leaving unqualified junior doctors to administer it in breach of official guidelines.

    The report, which also sets tough new guidelines on the use of shock therapy, was commissioned in 1993 and completed in 1995. Internal Scottish Office documents reveal the Government has stalled on publishing the report on at least three occasions.

    One leaked Government letter even claimed it was "essential" the report was published before February this year - in time for a national audit of shock therapy.

    But now campaigners fear the report may never be released as the Scottish Office has once again blocked its publication until after the general election.

    Alex Doherty, whose brother committed suicide after treatment, has pledged to publish the leaked copy of the report himself if the incoming government fails to release it immediately after the election.

    "This is the most important document produced on shock therapy in Scotland. It's dynamite" he said.

    Dr. Chris Freeman, who led the CRAG report team, said: "This report is the shock therapy Bible, but the powers that be have suppressed it".

    Freeman said he is dismayed by the delays and believes the next government will shun his findings. But he has promised to distribute the report himself if it is not published soon.

    "This report is so important that I'll make sure every hospital consultant in the country has a copy of it", he said.

    A Scottish Office spokesman said parliamentary rules prohibited the publication of reports during an election campaign.

    But the Scottish Office has yet to explain why the report has not been published prior to the start of the election race.

    Doherty said: "These rules didn't stop the Scottish Office publishing their report on E-coli last week".

    The failure of the Scottish Office to publish the CRAG report comes in the wake of tough new shock therapy guidelines issued by the Royal College of Psychiatrists.

    In a strongly worded letter leaked to the Big Issue in Scotland, the psychiatrists' body threatened to remove the right of hospitals to train doctors if they flout the new guidelines.

    Dr. Robert Kendell, Royal College president and former Scottish Chief Medical Officer, said: "We are adamant that these new guidelines will be effective and we're bringing out the big guns now to ensure that is the case".

    But Doherty said the moves were "too little, too late".

    "The time for guidelines is over. The Royal College have had every opportunity to put their house in order and have consistently failed. The use of shock therapy and the conduct of psychiatrists needs to be covered by legislation."

    Shock therapy, used to treat severe depression, passes an electric current through a patient's brain inducing an artificial epileptic fit.

    Although most doctors believe the therapy is safe and effective, there are concerns about possible side-effects including memory loss, impaired speech and complete vegetative coma. [The article is illustrated with a photo of Patricia Madden and the caption - Tragedy: Michael Madden believes his wife Patricia plunged into a vegetative state because she received 12 ECT treatments in 6 weeks. He begged the hospital to stop as he witnessed her physical and mental deterioration. She is now doubly incontinent and paralysed.]

    Animal tests even suggest electric shocks could cause irreversible genetic changes.

    The following is a transcription of an article appearing in 'Scotland on Sunday' on 20.1.1999:

    A patient committed a murder and another took his own life during an ECT research project in Scottish hospitals, it was revealed yesterday (Saturday).

    A leaked government audit shows disturbing evidence of unsupervised junior staff administering treatment and a higher number of "adverse effects" than expected, claimed relatives of ECT patients. They also said that there was alarming evidence of a lack of training in resuscitation techniques and a shortage of trained nurses.

    The secrecy surrounding the unpublished audit on electro-convulsive therapy (ECT) has also infuriated mental health campaigners. They said its remit was too narrow and failed to look at the issues of patient consent for treatment and later side-effects.

    The 10,000 three-year audit aimed at improving practices in ECT treatment was headed by Dr. Chris Freeman of the Royal Edinburgh hospital. SNP shadow health minister Kay Ullrich has criticised the lack of openness and is demanding that the audit be made public.

    "A public audit carried out on behalf of the taxpayer should be made public. The government prides itself on being open and transparent," she said. "This is not happening in this case. People are very concerned about the regulation and management of ECT and have a right to know what the findings are."

    Relatives of ECT patients who committed suicide before the audit took place said the unpublished information is "highly disturbing."

    "Draft four of the audit shows that as well as the murder and suicide, two women died and 28 people suffered a medical complication probably related to the treatment," said one relative. "These 1314 patients received 8672 treatments. Yet the information booklet on the project states that something goes seriously wrong in only one in every 50,000 treatments. These figures don't add up and it will be interesting to see what is in the audit when it eventually comes out."

    Alex Doherty from Clydebank has campaigned against how badly the audit has been run.

    "This project was run by psychiatrists for psychiatrist," he said. "I attended a conference earlier this month on the project where David Carter, the Chief Medical Officer, admitted the results would be shocking. I'm really concerned about the lack of discussion on consent and the adverse incidents which occurred during the audit."

    George Ronald, director of the Scottish Users Network, said he was disappointed that his group had not seen a copy of the audit. "It seems highly peculiar to exclude the major patients' groups and I am writing to the Scottish Executive for an explanation."

    Richard Norris, head of policy at the Scottish Association for Mental Health, said he was not opposed to an audit but that both sides of the argument for ECT need to be heard. "The audit is not a substitute for the high quality research that is needed to answer the controversial questions," he said. "The issue of consent, side-effects, the long-term impact and relapse rates need to be examined and patients' opinions should be asked."

    A spokesman for the Scottish Executive said: "We cannot comment on the clinical aspects of the research. Our purpose in backing the project was to look at ECT treatment on the basis of fact. The group which conducted the Audit went out of its way to involve groups and users."