Electroconvulsive therapy (ECT) continues to be used in England without comprehensive national auditing. In a new Psychology and Psychotherapy: Theory, Research and Practice study, experts recommend that national audits of ECT be reinstated, and they call for an investigation into why ECT is still excessively administered to older people and women.

For the study, information was gathered on usage, demographics, consent, and adherence to the guidelines of the National Institute of Clinical Excellence (N.I.C.E.) and to England's Mental Health Act. Freedom of Information Act requests were sent to 56 National Health Service Trusts.

The study noted that the number of people currently receiving ECT in England annually is between 2100 and 2700, and falling. There was a 12-fold difference between the Trusts with the highest and lowest usage rates per capita. Most recipients are still women (66%) and over 60 years of age (56%). More than a third (39%) is given without consent; with 30% of Trusts not adhering to mental health legislation concerning second opinions. At least 44% were not using validated measures of efficacy, and at least 33% failed to do so for adverse effects.

Only four provided data for positive outcomes or adverse effects, and none provided any data on efficacy beyond the end of treatment. Only ten of the 56 Trusts were able to report how many people received psychological therapy prior to ECT in compliance with government guidelines.

"The huge regional variation in usage shows that whether you are given electroshock is determined by the personal opinions of individual local psychiatrists. This geographical lottery is not an evidence-based approach to treatment," said lead author, Professor John Read of the University of East London. "The continued targeting of older women remains an unexplained phenomenon and a serious concern. The failure to properly monitor outcomes or the memory loss so often caused by ECT is, to be blunt, medical negligence, and forcing people to undergo this dangerous procedure against their will, without first offering them other treatments that might address the actual causes of their depression -- such as loss, loneliness and poverty -- indicates a mental health system in urgent need of treatment itself."

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References:

John Read, Christopher Harrop, Jim Geekie, Julia Renton. (2017). An audit of ECT in England 2011-2015: Usage, demographics, and adherence to guidelines and legislation. Psychology and Psychotherapy: Theory, Research and Practice. DOI: 10.1111/papt.12160