Madam, – The recent debate about electroconvulsive therapy (ECT) (Healthplus, February 2nd) is long overdue. ECT is a highly controversial treatment. It has been the subject of debate and review in other countries in recent years, which has led to it being effectively abolished in Italy, and to it being available only in specialist centres in Belgium and Germany.
However, it remains, in certain quarters in Ireland, a commonly used tool in the psychiatrist’s kit, and many psychiatrists are very defensive about retaining it as a valuable alternative to other treatments. Many recent studies and reviews of literature (particularly user-led ones) have served to re-emphasise the controversial nature of the treatment, pointing to the undeniably common side effect of permanent memory loss, the dubious nature of the “science” behind ECT and the lack of solid and convincing evidence as to its longer-term efficacy.
However, the current focus on the merits or otherwise of ECT is muddying the waters of the issue that is at the centre of the proposed amendment to Section 59 (b) of the current Mental Health Act.
This issue is to do with the rights of a person detained under the Mental Health Act, to have proper representation when a decision is being made to perform ECT on that person.
Under the present regime, ECT can be given to a non-consenting patient solely on the signature of two consultant psychiatrists. In any other branch of medicine it would be outrageous to consider that a next-of-kin need not be consulted.
Any such decision should be a multidisciplinary one, taking into account the opinions of other professionals involved in the patient’s care, as well as the next-of-kin and any signed advance directive that the patient may have made.
The current Mental Health Act is out of line with the progressive national mental health policy, A Vision for Change. The proposed amendment should be whole-heartedly supported. – Yours, etc,