Government responds to electroconvulsive therapy report
The Ministry of Health today announced that the Government would partially or fully support majority of the Health Select Committee’s recommendations on electroconvulsive therapy (ECT).
Last November, after considering a petition requesting that ECT therapy is not administered to children, pregnant women and the elderly, the committee made eight recommendations to the Government.
Several of these recommendations focused on introducing regulatory controls on ECT use, particularly in relation to various patient groups, while others related to consent and monitoring issues. One recommendation called for ECT to be used only as a treatment of last resort once other options had been considered.
Dr David Chaplow, Director of Mental Health, said that in response to the committee report, the Government would partially or fully support seven of its eight recommendations.
``Generally, we are supportive of recommendations that can comfortably be accommodated without the risk of intervening in matters of clinical judgment,’’ he said.
``It is also important to remember that in practice, ECT is often a treatment of last resort in some groups, including children, adolescents, and pregnant women."
Dr Chaplow noted that the Ministry of Health has already started planning a review of the Mental Health (Compulsory Assessment and Treatment) Act 1992. The review would contribute to the Government’s response to a number of the committee’s recommendations, including issues concerning consent and the use of advance directives.
ECT has been used in the treatment of mental illness for more than 60 years. In 2003, the Health Select Committee recommended that a comprehensive, independent review be undertaken on the safety and efficacy of ECT and the adequacy of controls on its use in New Zealand. The review concluded that ECT continues to have a place as a treatment option for consumers of mental health services in New Zealand, and that banning its use would deprive some seriously ill patients of a potentially effective and sometimes life-saving treatment.
``Nevertheless, ECT can create anxiety among some patients and families, and the treatment still generates significant interest among some members of the public and various public interest groups,’’ Dr Chaplow said.
``While ECT remains a controversial treatment, partly because of a risk of cognitive impairment and, in particular, memory loss, I do not consider the evidence about risks and side effects to be conclusive, and note that new evidence is still emerging. We are concerned that if ECT is made only a treatment of last resort, increased suffering and illness-related morbidity, and even increased mortality, may result.”
Petition background
On 27 November 2007, the Health Committee tabled its report in the House of Representatives, setting out its consideration of a petition from Helen Smith requesting that ECT is not administered to children, pregnant women and elderly people.
Helen Smith also requested that:
the use of ECT with children, pregnant women and the elderly be reviewed with a view to banning or severely restricting its use in these groups.
the elderly at least be given the opportunity to formally decline ECT prior to becoming elderly or unwell when offered, despite opinions of other family members and psychiatrists. If they do not want ECT, this wish should be respected.
there be stricter regulatory reporting and controls in place.
the use of ECT be made on a voluntary basis.
Electroconvulsive (ECT) therapy
ECT is a therapeutic procedure in which a brief pulse of electricity is delivered to a patient’s brain to produce a seizure. It is an effective treatment for various types of mental illness, including depressive illness, mania, schizophrenia, catatonia and other neuropsychiatric conditions, and in cases where medication is contraindicated, or is not providing sufficient relief from symptoms.
ECT is administered under anaesthesia and with muscle relaxants. The end result is that the patient drifts off to sleep and wakes up a short time later unable to recall details of the procedure. The most common side-effects of ECT are confusion and memory loss of events surrounding the period of ECT treatment. This confusion and disorientation typically clear within an hour. More persistent memory problems are variable and can be minimised with the use of modern treatment techniques, such as applying both stimulus electrodes to the right side of the head (unilateral ECT).
The use of ECT as a treatment for mental disorder in New Zealand has become safer in recent decades largely because of various changes in the technology and techniques used in administering it. The rate of ECT use in New Zealand has declined considerably as more effective drugs for treating depression have become available.
For full details of the Government’s response to the Health Select Committee’s report on the petition of Helen Smith, see:
http://www.parliament.nz/en-NZ/PB/Presented/Papers/