Mental Health Weekly, 05-22-1995

Just after mental health leaders in the state of Texas appeared to fight off a move to ban electroconvulsive therapy (ECT) there, federal mental health officials unwittingly found themselves in their own ECT imbroglio.

Angry advocates for the mentally ill have fired off letters to ConFess and the Center for Mental Health Services (CMHS) in response to an April CMHS memo that expressed the agency's interest in furthering discussion of "electroconvulsive therapy, involuntary treatment and related issues." Advocates say any attempt to couple ECT and involuntary treatment is misguided and plays into the hands of what they consider to be extremist groups, such as those that this year tried unsuccessfully to persuade Texas legislators to ban ECT outright.

"Of all the things that are at a crisis point in a rapidly changing health care environment, CMHS does this?", Laurie Flynn, executive director of the National Alliance for the Mentally Ill, told MHW. "When are they going to spend time on (issues such as) patients' access to clozapine?"

Responding to concerns from groups such as the National Alliance for the Mentally Ill, the American Psychiatric Association and the National Depressive and Manic-Depressive Association, CMHS director Bernard S. Arons, M.D., told MHW that the federal agency never intended to give ammunition to those who consider ECT an outright dangerous practice. Scientific evidence confirms the efficacy of the treatment, which is used most often in cases of severe affective disorders such as major depression, Arons said.

As for CMHS's intent in issuing the April memo, which Arons explained was to encourage a larger discussion of finding preventive ways to reduce the need for involuntary mental health treatment, Arons said, "We may not have been as clear as possible."

CMHS mentioned ECT in its memo, Arons said, because it recently has received many letters about the appropriateness of ECT from both sides of the fence.

But advocates fear that ECT opponents, included those affiliated with the Church of Scientology, will use the invitation to discuss "ECT and involuntary treatment" to storm Capitol Hill with proposals for a national ban.

In Texas, a move to ban the practice statewide appears to have fizzled for 1995. After an April 18 hearing in which 60 members of the public addressed a House of Representatives committee on a proposed ban (see MHW, April 17), the committee returned the ECT bill to the subcommittee level, essentially killing its chances for this year.

William H. Reid, M.D., medical director of the Texas Department of Mental Health and Mental Retardation, told MHW that he believes the bill would have failed had it come to a final vote.

Some Texas patients who say ECT harmed them argued for the ban, saying there is no accountability on the use of the practice among mental health professionals. Opponents of a ban say the anti-psychiatry Citizens Commission on Human Rights, founded in 1969 by the Church of Scientology, is fueling the debate in Texas and nationally.

John Bush, executive director of the Texas Society of Psychiatric Physicians, told MHW that ban supporters eventually will be back before state legislators. "This group has vowed to ban ECT either in future legislative sessions or in the courts," he said.

As for the recent national flare-up, advocates have asked Congress to request that CMHS scrap any plans to include ECT, which is usually administered on a voluntary basis, in any review of involuntary treatment issues. The CMHS memo mentions plans to conduct "further analyses of the 1985 (National Institute of Mental Health) Consensus Development Conference on ECT which indicated the efficacy of ECT for some patients. "

Flynn remarked, "This is taking the issue of involuntary treatment, which is highly controversial, and entangling it with ECT, which shouldn't be."