Electroconvulsive Therapy (ECT) is a treatment used in the psychiatric field worldwide. It involves delivering an electrically induced seizure to anaesthetised patients to alleviate symptoms of mental illnesses particularly those associated with serious disturbances of mood.
Effectiveness of ECT
Using modern techniques, ECT is safe and clinically effective. It has been shown to result in improved quality of life in both the short- and long-term and, in some cases, may be life-saving.
Scientific studies have found that ECT is the most effective treatment for a major depressive episode and has a response rate of over 70 per cent. ECT is also used to a lesser extent in the treatment of other mental illnesses.
After treatment, drug therapy can be continued, and some patients receive continuation or maintenance ECT.
Approved treatment under the Mental Health Act (2007)
In NSW, ECT is an approved treatment under Division 3 of the NSW Mental Health Act 2007 (The Act). Section 97 of the Act requires a register of the administration of ECT treatments to be kept at each mental health facility or other approved place at which ECT is provided.
Where ECT can be given
ECT can only be given in an approved hospital or declared mental health facility. Two doctors must be present for each treatment. One doctor must be experienced in giving ECT and the other must be an experienced anaesthetist. Nursing staff are also present to ensure that the person is well cared for.
The Act requires that, in the case of voluntary patients, at least two medical practitioners (at least one of whom must be a psychiatrist) agree that the person can give informed consent and that the treatment is “reasonable and proper … and … necessary or desirable for the safety or welfare of the person” (s93). If the authorised medical officer is unsure whether a patient is capable of giving informed consent, they may apply to the Mental Health Review Tribunal for a determination.
Mental Health Review Tribunal
The Mental Health Review Tribunal is a specialist quasi-judicial body constituted under the Mental Health Act 2007. It has a wide range of powers that enable it to conduct mental health inquiries, make and review orders, and to hear some appeals, about the treatment and care of people with a mental illness
The Tribunal must review all ECT applications for involuntary patients, even where the person consents to ECT. ECT can only be given to involuntary patients where the Tribunal has determined that the person is capable of giving informed consent to the administration of ECT and has given that consent.
Or, if consent cannot be established, that ECT is a reasonable and proper treatment and is necessary and desirable for the safety or welfare of the patient (s96).
The Tribunal must specify the number of ECT treatments that are approved, with a maximum of 12 treatments except in special circumstances where it is considered that the higher number of treatments is justified.
NSW Health has a state-wide policy that defines minimum standards for the use of electroconvulsive therapy (ECT) in NSW: Electroconvulsive Therapy: ECT Minimum Standards of Practice in NSW.