More and more New Zealand mental health patients are being given non-consensual electroconvulsive therapy. Known as ECT, the treatment was administered without consent almost 1000 times last year—up 65 percent since 2015. The increasing trend, which comes despite the New Zealand government’s stated commitment to phase out coercive treatment, has left mental health advocates concerned about how dedicated the sector really is to respecting patients’ rights.
ECT is a mental health treatment where electric currents are passed through the brain, triggering a seizure. Of the 251 people who received it in 2016, 41 per cent did not consent, with the majority classed as ‘unable to consent’. 10 patients had capacity and said no, and 92 were deemed unable to consent.
The latest Office of the Director of Mental Health report, published yesterday, revealed a sharp upwards trend in non-consensual ECT treatments over the past three years. The total number of non-consensual treatments has almost doubled every year, from 259 in 2014, to 576 the following year, and 954 in 2016.
ECT is often used to treat severe depression and is today a controlled process, done under general anesthesia. However, the treatment remains controversial and can have significant side effects. To have ECT, patients must consent to treatment in writing. If they don’t, ECT can still be administered if the clinician receives a positive second opinion from another appointed psychiatrist—typically when a patient is considered too unwell to consent.
"The idea of having ECT forced on me scares the shit out of me, even having had it and knowing what it is like."
Caleb* a man in his 20s who had a positive experience with consensual ECT said the benefits from the treatments were life-changing—but consent was an essential part of the process.
He had 12 sessions in total. “It was the difference between being chronically suicidal and feeling totally fine…I remember thinking ‘why didn’t I have this years ago?’ I’d struggled through years of non-response to a wide range of drugs.”
But Caleb said while his outcome from ECT was good, he believes his consent was crucial to making it a positive experience.
“Nearly all of that was down to how involved and informed I was. Having such a serious treatment forced on me would have been absolutely terrifying and traumatising. I think a lot of the reputation of ECT, and historical accounts of the horrors of it, stem as much from the way it was forced on people in the past as it does the nature of the treatment itself.”
“The idea of having ECT forced on me scares the shit out of me, even having had it and knowing what it is like.
“Pretty much the worst experience of my life was being detained under the Mental Health Act. It had nothing to do with the physical circumstances of it… the feelings of loss of power and lack of agency were overwhelming,” he said. “I think having ECT forced on me would be like that, but a million times worse.”
"The increase in forced ECT rates across the country flies in the face of the collective mental health commitment from all sectors to eradicate coercive practice"
Mental health advocates say the new numbers are concerning. Taimi Allen, CEO of mental health advocacy group Changing Minds, said the increase was at odds with the Ministry of Health’s commitment to reducing coercive practices in mental health, but said ECT can be valuable to people who chose to take part in the treatment via an informed consent process.
“The increase in forced ECT rates across the country flies in the face of the collective mental health commitment from all sectors to eradicate coercive practice,” said Allen.
“This proves that despite good intentions, coercion will still be an issue in Aotearoa until a menu of recovery alternatives for people using mental health services is the norm rather than the exception.”
The Ministry of Health has said one of its priorities is to “reduce the use of restraint in all its forms and to encourage the use of least restrictive practices”.
Mental Health Foundation Chief Executive Shaun Robinson said that although ECT can be an effective treatment for some people it can have long term side-effects and should only be used in extreme cases. “It is very concerning to see that the total number of ECT treatments not able to be consented to has almost doubled between 2015 and 2016,” he said.
“Removing an individual’s right to decide their own medical treatment can result in a person being treated against their will, which we regard in many instances as extremely harmful and a violation of human rights.”
Other treatment options—such as talking therapies and medication—need to be made more easily available throughout New Zealand, said Robinson.
“More needs to be done to ensure that mental health services can reach people earlier to prevent circumstances from escalating to the point of ECT being administered.
"Compulsory ECT is a breach of human rights and should not be authorised in legislation. If the increase in compulsory ECT is based on accurate figures it is an outrage - it needs to be investigated and stopped.”
Mental health consumer advocate Mary O’Hagan said ECT was still highly controversial, with some patients experiencing no benefits from the treatment, and distressing side-effects, such as losing large chunks of memory. “Compulsory ECT is a breach of human rights and should not be authorised in legislation. If the increase in compulsory ECT is based on accurate figures it is an outrage - it needs to be investigated and stopped,” she said.
The Director of Mental Health, John Crawshaw, wrote in the report that the increase may be partly due to “focused efforts” to improve reporting on non-consensual ECT—implying that hundreds of incidents of the treatment being administered without consent may not have been recorded in previous years. In a partial update on the Ministry’s efforts to reduce coercive care, last week the Ministry of Health publicly released submissions around how the Mental Health Act relates to the New Zealand Bill of Rights Act 1990 and the Convention on the Rights of People with Disabilities.
Respect for the rights and wishes of patients was a key theme of the submissions. In particular, they covered inconsistencies between the Mental Health Act and New Zealand’s human rights obligations, conflict between a recovery model and risk avoidance, the need to improve family/whanau consultation, and a greater need to prioritise eliminating seclusion and restraint.
At the time, Crawshaw said:
“We are reviewing aspects of the administration of the Mental Health Act including informed consent and second opinion processes; opportunities for increasing tangata whaiora/service user involvement in care planning and decision-making, including in relation to treatment options and the use of supported decision-making approaches in mental health”.
ECT Treatments By the Numbers
People given ECT who did not have the capacity to consent: 92
People given ECT who had capacity and refused consent: 10
People who consented to ECT: 149
Number of administrations not able to be consented to: 952
Number of administrations consented to: 1794
The total number of ECT treatments not able to be consented to has been increasing:
2016: 954 The number of people not consenting has also been increasing:
204 consenting patients
43 non-consenting (17 percent of total) 2015
154 consenting patients
71 non-consenting (32 percent of total)
149 consenting patients
102 non-consenting (41 percent of total)
Follow Jess on Twitter: @Jess_McAllen
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