Significant progress in recent years notwithstanding, elements of mental health legislation in the Republic remain outdated. Patients' rights need strengthening along with greater oversight of mental health services. The decision to end the practice of administering electroconvulsive therapy (ECT) to patients with psychological problems who refuse to consent to the treatment, announced by Minister of State for Health Kathleen Lynch, is welcome. At present the Mental Health Act states that ECT may be administered where a patient is "unable or unwilling" to give consent once it has been approved by two consultant psychiatrists.
Treating people with mental health problems without their consent has no place in 21st century medical practice. Under proposals from an expert group, it will no longer be possible to administer ECT to a person who has capacity and does not consent to treatment. ECT is an effective treatment used in limited circumstances for patients with severe depressive illness, catatonia or mania, who have not responded to other treatment. About 450 people receive ECT in Ireland every year; some 90 per cent do so having given consent to the procedure. Administered under anaesthetic, ECT is a proven and relatively safe treatment that can be life-saving in people who are actively suicidal or who have become physically debilitated from severe depression.
As part of a continuing move to a recovery-based philosophy in mental health, the proposed legislative changes announced by the Minister make sense. Ms Lynch noted the expert panel has produced recommendations “which will change, not just our legislation governing mental health, but will change how people who have difficulties with their mental health interact with the [health] service”.
The changes will also influence how healthcare professionals engage with people with psychological ill-health, underpinning a facilitatory and recovery-based approach. With a total of 165 proposals, the report signals a significant step forward for mental health in the State.