Madam, – I would like to respond to Dr Muiris Houston’s article about electroconvulsive therapy (HEALTHplus, February 22nd). While the article is generally balanced and well argued, it fails to tackle the central concern in the ECT debate in Ireland at the moment. This concerns the use of ECT when a patient cannot, or will not, give consent for the procedure. At present, ECT can be given in such circumstances simply on the say of two consultant psychiatrists.
But psychiatrists differ greatly in their use of the treatment. The most recent Mental Health Commission figures (for 2009) show a continuing massive variation in the use of ECT across the country. It would appear that while most psychiatrists now use ECT very cautiously (perhaps only in the sort of scenario described by Dr Houston) some are “ECT enthusiasts” and have a much lower threshold. They will see an indication for ECT where other psychiatrists will look for alternative interventions.
The Irish mental health service is sectorised, which means that patients and their GPs have no control over which psychiatrist will be allocated to them. In these circumstances, I believe that it is simply wrong that the psychiatrist should be able to decide on the use of such a controversial treatment without the patient’s consent.
That they can do so without consultation with relatives and other professionals, or take into account an advance directive signed by the patient, is outrageous. As it now stands, the Mental Health Act 2001 provides protection for the psychiatrist, not the patient. The amendments being proposed by the Department of Health, as outlined in its recent response to the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, will not materially alter the situation. Our national policy on mental health, A Vision for Change, advocates a move to a less paternalistic, more “user-centred” philosophy of care. As it now stands, this is contradicted by our current Mental Health Act. – Yours, etc,