A newly-published audit of electroconvulsive therapy (ECT) clinics run by NHS mental health trusts has concluded that both the administration and monitoring of ECT in England are failing to guarantee the safety of patients, according to an University of East London (UEL) -led review.
Lead researcher Dr John Read, professor of clinical psychology in the School of Psychology at UEL, believes the procedure should be suspended pending robust research.
ECT involves the passing of sufficient electricity through the brain, under general anaesthesia, to cause a seizure. While some claim the therapy is a safe and effective treatment for severe depression, some patients report that it causes persistent or permanent memory loss.
The recently-published A Second Independent Audit of Electroconvulsive Therapy in England, published in the British Psychological Society journal, Psychology and Psychotherapy: Theory, Research and Practice, found that about 2,500 people are given ECT annually in England. The majority are women (67 per cent), and over the age of 60 (58 per cent). More than one in three (37 per cent) are being given ECT under the Mental Health Act, which grants psychiatrists the power to treat people against their will.
In responses to a records request by the researchers, the majority of NHS trusts did not provide any data for positive outcomes or for adverse effects during treatment (usually a three-week period involving about 10 electroshocks). None provided any follow-up data on efficacy or adverse effects beyond end of treatment.
The Care Quality Commission (CQC) is formally charged with the task of regulating ECT in England. The Royal College of Psychiatrists (RCPsych) runs a voluntary, peer-led accreditation network, the ECT Accreditation Service (ECTAS). ECTAS is the only body in England focused specifically on ECT.
ECTAS uses a system of peer review intended to improve the quality of ECT services, using standards agreed by the network. It aims to support members in raising standards. But ECTAS does not monitor some of the issues addressed in the independent audit; such as how many ECT patients had first been offered psychological treatment in compliance with NICE (National Institute for Health and Care Excellence) guidelines.
ECTAS has no powers to sanction ECT clinics that fail to meet even their limited set of standards. Currently 23 per cent of ECT clinics that are members of ECTAS in England are not listed as accredited. Furthermore, 4 per cent of clinics are not members.
The findings of the recent audit, and of two other audits conducted by the same research group, have been fed into a campaign by a group of clinicians, researchers and ECT recipients asking the government for an independent review of ECT, addressing both accreditation and regulation. They are supported by Mind, the Royal College of Nursing, the Association of Clinical Psychologists and Headway, the brain injury association, plus many MPs.
ECT is a potentially very dangerous procedure which, if it is to be used at all, requires the most stringent scrutiny. Relying on the Royal College of Psychiatrists to drive up standards in ECT clinics is not ideal, perhaps because of their obvious conflict of interest. It is hard for them to acknowledge that a treatment used by some of their members causes high rates of memory loss, and is largely ineffective, so their role seems half-hearted and tokenistic,”
Dr John Read, professor of clinical psychology in the UEL School of Psychology, said.
The UK government guidelines (National Institute of Clinical and Health Excellence, 2017) state, “Consider ECT for acute treatment of severe depression that is life-threatening and when a rapid response is required, or when other treatments have failed. Do not use ECT routinely for people with moderate depression but consider it if their depression has not responded to multiple drug treatments and psychological treatment.”
The current audit can’t address the question ‘How many people had ECT without receiving a NICE recommended psychological therapy?’ because only 2.7 per cent of the 37 responding Trusts (1.8 per cent of all 56 Trusts) answered the question.
The audit concluded,
Given the apparent failure of current monitoring and accrediting ECT clinics in England, by the Royal College of Psychiatrists' ECT Accreditation Service (ECTAS), an independent government sponsored review is urgently needed."