Shine-Supporting People Affected by Mental Ill Health has ‘Significant’ Concerns about the Involuntary Use of ECT

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Press Release 8 June 2010

Shine – Supporting People Affected by Mental Ill Health has published its submission to the Department of health and Children regarding the proposed amendment of Section 59 (B) of the Mental Health Act 2001, which relates to the involuntary use of electroconvulsive therapy (ECT).

At present, ECT can be given to a detained patient without their consent under the terms of section 59 (B) of the Act, which puts the authority to order this treatment in the hands of the consultant psychiatrist who has care of the patient, and one other consultant psychiatrist.

According to John Saunders, Director of Shine, "we have significant concerns about the legislation as it stands because a patient who is involuntary detained and lacking capacity to make independent decisions has no recourse to query or dispute the prescription of ECT after the fact. Furthermore, it is difficult to be confident that ECT is being used only as a last resort and in situations where it is the only useful intervention.”

Mr Saunders continued by noting that, “the evidence base for the efficacy of ECT is at best unclear and uncertain. We recommend that the words ‘or unwilling’ be removed from the legislation."

Shine makes the following recommendations in relation to Section 59 (B) of the Mental Health Act 2001:

1. That the words “or unwilling” be removed from Section 59b of the Mental Health Act
2. That the responsibility for prescribing ECT to patients that are unable to give informed consent be undertaken in a different way. Shine recommends that a standing ECT consent group be established. This group should be comprised of a barrister or solicitor who would chair the group, a consultant psychiatrist, a service user, a family member and a layperson. At the very least, in the interim of changed legislation, the decision to administer ECT should be broadened to include the views of other professionals in the treatment team.
3. That capacity legislation is introduced as a matter of urgency.
4. That any advance directive made by the patient be included fully and rigorously in the decision making process.
5. That the views of family members be fully explored, taken into account and recorded.
6. That research is undertaken to establish the facts about the administration of ECT.  What conditions is it prescribed for; under what circumstances is it prescribed? What dosages are prescribed in relation to the severity of symptoms, how is recovery or improvement measured? How are the effects of cognitive impairment measured?
7. That, separately, research be undertaken to establish the views and experiences of service users.
8. That national clinical guidelines on the prescribing and administration of ECT for voluntary and involuntary patients be drawn up and applied to all mental health services
9. That this review of Section 59b be taken in the context of an urgent need for a thorough review of the entirety of the 2001 Mental Health Act.

- Ends -

For further information, please contact:

John Saunders, Director, Shine – Supporting People Affected by Mental Ill Health

Mobile: 0879271292; Tel: 01 860 1620

Information Helpline: 1890 621 631

Website: www.shineonline.ie

Shine is the national organisation dedicated to upholding the rights and addressing the needs of all those affected by enduring mental illness including, but not exclusively, schizophrenia, schizo-affective disorder and bi-polar disorder, through the promotion and provision of high-quality services and working to ensure the continual enhancement of the quality of life of the people it serves.