Mental health law review proposes end to forced ECT

A major review of mental health legislation is to recommend an end to the practice of administering controversial electroconvulsive therapy (ECT) to patients who are unwilling to give consent to the treatment.

A Government expert group tasked with reviewing the Mental Health Act (2001) recently completed its report which is likely to be published shortly by Minister of State Kathleen Lynch.

It is understood to contain a number of proposals to strengthen patients’ rights, extend the remit of watchdog bodies and place a greater emphasis on children’s services.

The current legislation is regarded by many campaigners as outdated given the growing emphasis on community-based services and demands for greater autonomy by patient groups.

Amendment

The proposal to end the practice of forced ECT use is understood to recommend amending the Mental Health Act to ensure that those who do not wish to receive ECT – used to treat specific types of major mental illnesses – or other medicine will not be forced to do so in future.

Section 59(b) of the Mental Health Act states that forced electroconvulsive therapy may be administered where a patient is “unable or unwilling” to give consent once it has been approved by two consultant psychiatrists.

The steering group is expected to support the deletion of the word “unwilling”.

The use of forced ECT has been in decline in recent years. Official statistics compiled in 2013 by the Mental Health Commission show a fall in the use of the treatment for the fifth year in a row.

Given the growing emphasis on care in the community, the steering group is also understood to support an expansion of the remit of the Mental Health Commission, the State’s watchdog for psychiatric services.

At present the commission has statutory responsibility to inspect “approved centres” once a year. These are typically acute mental health units of large hospitals or psychiatric hospitals.

The report is expected to support extending this responsibility to community mental health teams, home-based treatment teams and community residences given that the bulk of treatment takes place in these settings.

Young people

Children also feature prominently in the report’s proposals, say sources, and advocate that the needs of young people should be explicitly recognised in a standalone part of any revised legislation.

It is likely to propose a set of guiding principles which reflect the UN Convention on the Rights of the Child.

On the issue of consent to treatment, it is understood to state that children aged 16 or 17 and upwards should be presumed to have the capacity to consent to or refuse treatment. Admission or treatment for young children should require the consent of parents.

It is also expected to propose the scope of existing mental health laws should be extended to include voluntary patients, and the protections provided for involuntary patients should, where appropriate, apply equally to voluntary patients.