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Why is electroconvulsive therapy still so widely practiced?

Fay Selvan, CEO and Nicky Lidbetter, Director of Mental Health

Every so often, an email arrives advising of a new report or campaign. On this occasion, it was an email from Communities for Holistic, Accessible and Rights-based Mental Health (CHARM), in which we were reminded and appalled that electroconvulsive therapy (ECT) is still being widely practiced, at least in some areas.

Despite ECT being a treatment recognised by NICE for only a small number of conditions, including people with entrenched, or as it is often termed, ‘treatment resistant’, depression, some eating disorders and schizophrenia, many NHS Mental Health Trusts do not use it at all. Presumably, they see no need to as they have other more effective treatments to offer. In a health system that prides itself on evidence-based treatment, it is, as Professor Peter Kinderman says, extraordinary that “we now live in a world in which the best evidence that the Royal College of Psychiatrists has been able to muster for the real-world effectiveness of ECT exactly parallels the claims for homeopathy” (Council for Evidence Based Psychiatry, 2021). So, the evidence base for ECT is shaky, but perhaps most importantly, where it does ‘work’ as a treatment, we don’t know how or why.

What we do know is that lots of people report the negative impacts that having ECT had on their memory and sense of self. As one person told Big Issue North recently, “after ECT I’d been left so damaged that I didn’t know how to count money out. I couldn’t read. It took me five years to be able to read again. And that started off with having to read kids’ books. I had lost quite a lot of my vocabulary.”

Whether or not you get ECT is a lottery – and not a good one. Use of ECT across the country varies and it seems to be largely down to the individual treatment preferences of the psychiatry team in charge. If you are unlucky enough to live in Manchester, you are a whopping 43 times more likely to be administered ECT than if you were treated in the neighbouring Merseycare NHS Trust (CHARM, 2021). We also know that some people are more likely to be given ECT than others: 67% of recipients are women and 58% are over 60 years of age. Worse still, more than a third do not consent to the treatment (Read, Harrop, Geekie, Renton & Cunliffe, 2019).

The National Institute for Health and Care Excellence (NICE) guidance on the treatment of Depression (NICE, 2009) is going to be updated shortly. We at Big Life will be making clear our opposition to ECT as a treatment option. However, we don’t need to wait for the guidance to change, as we are calling on all our NHS partners to urgently review their use of ECT.

The use of ECT on particular groups in society, the high use of ECT without consent and the well-documented reports of the approach in terms of the adverse effects it can cause to people’s lives are red flags that we should all be concerned about.

References

  • Communities for Holistic, Accessible and Rights-based Mental health (2021). Greater Manchester Mental Health Trust uses Electro-convulsive Therapy at one of highest levels in country. We call for review. Retrieved from https://charmmentalhealth.org/2021/04/13/electroconvulsive-therapy-to-be-provided-at-the-new-park-house-psychiatric-hospital/
  • National Institute for Health and Care Excellence (2009). Retrieved from https://www.nice.org.uk/guidance/cg90/resources/depression-in-adults-recognition-and-management-pdf-975742636741
  • Read, J., Harrop, C., Geekie, J., Renton, J., & Cunliffe, S. (2021). A second independent audit of electroconvulsive therapy in England, 2019: Usage, demographics, consent, and adherence to guidelines and legislation. Psychology and Psychotherapy: Theory, Research and Practice.
  • Royal College of Psychiatrists (2021). Electroconvulsive therapy (ECT). Retrieved from https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/ect