By Jeffrey Green
Mental Health Weekly, 04-17-1995

At a time in which electroconvulsive therapy (ECT) is enjoying perhaps its greatest level of acceptance ever in the mainstream mental health community, a Texas bill that would ban the practice has outraged mental health professionals.

The Texas House of Representatives' Public Health Committee on April 18 will hold a public hearing on the bill, which if passed would make Texas the only state to ban use of ECT in all cases. Amid an atmosphere of psychiatric-hospital scandal two years ago, Texas lawmakers adopted a ban on ECT for patients 16 years old and younger, along with strict regulations governing the use of the treatment for adults.

Mental health professionals both within and outside Texas are assailing the latest proposal, saying it is being fueled by the Citizens Commission on Human Rights, a group the Church of Scientology founded in 1969 (see MHW, June 6, 1994).

A number of patients who say electroconvulsive therapy harmed them also are fighting for the ban, but critics of the bill argue that those who oppose any form of mental health treatment have taken the lead role in the effort.

"Should this bill pass, it will hurt our patients and our ability to provide the best care possible," William H. Reid, M.D., medical director of the Texas Department of Mental Health and Mental Retardation, told MHW. Reid stressed that his opinion on the bill is his own and does not represent a position of his agency, which cannot take official stands on proposed legislation.

Reid said that with improvements in anesthesiology and more knowledge of appropriate durations of ECT for certain patients, the procedure is safer than ever. Professionals use ECT most often in severe cases of affective disorders, such as the most debilitating cases of major depression.

"ECT generally is used for those people that are so sick that something definitive must be done to keep them alive," Richard Weiner, M.D., an associate professor of psychiatry at Duke University and chairman of the American Psychiatric Association's task force on ECT, told MHW.

But those who argue against the practice allege that in too many cases, people are suffering harmful effects or worse from the procedure, which usually is administered over several sessions.

Linda Andre, director of the New York-based Committee for Truth in Psychiatry, told MHW that ECT resulted in her losing five years' worth of memory. She says the Texas bill is necessary because state officials are not enforcing regulations enacted two years ago, requiring documentation of all ECT procedures and records of any deaths associated with the practice.

"They are not reporting deaths due to ECT, and are attempting to attribute them to other things," Andre said.

But Reid said there has been full disclosure of all statewide data on the use of ECT in the 18-month period since the 1993 law took effect.

Of the eight Texans during that period who died within two weeks of receiving an ECT treatment, two had cases in which the death arguably could have been related to the anesthesia administered before treatment, Reid said. Officials found no connection between the patient's death and ECT in any other cases, he said.

Reid added that about 22,000 ECT treatments occurred during the 18- month time frame, with women receiving about two-thirds of the treatments and persons of color receiving the treatment less often than whites. Nearly all such treatments in Texas occur in the private system, with more and more taking place on an outpatient basis, Reid said.

Though several mental health professionals believe the Texas bill ultimately will not pass, many worry about the kind of emotion an event such as this week's public hearing could generate. "We're dealing with the Texas legislature, and anything can happen in the Texas legislature, " John Bush, executive director of the Texas Society of Psychiatric Physicians, told MHW.

A broad coalition of Texas mental health professionals and advocates, generally representing the entire mental health community there, have joined forces to oppose the bill, which would impose criminal penalties on practitioners who violate a ban.

Some of the groups arguing against the legislation are the Texas Society of Psychiatric Physicians, the Texas Medical Association, the Texas Depressive and Manic-Depressive Association, the state Alliance for the Mentally Ill and Texas Mental Health Consumers.