A second independent audit of electroconvulsive therapy in England, 2019: Usage, demographics, consent, and adherence to guidelines and legislation

Abstract

Objectives. To assess progress towards improving the administering of electroconvulsive therapy (ECT) in England since an audit covering 2011, 2013, and 2015. The same information was gathered, for 2019, on usage, demographics, consent, and adherence to national guidelines and the Mental Health Act.Design and Methods. Freedom of Information Act requests were sent to 56 National Health Service Trusts.Results. Thirty-seven trusts (66%) provided data. The gradual decline in the use of ECT in England has levelled off at about 2,500 people per year. There was a 47-fold difference between the Trusts with the highest and lowest rates per capita. Most recipients are still women (67%) and over 60 (58%). Only one Trust could report how many people received psychological therapy prior to ECT, as required by government (NICE) guidelines. More than a third of ECT (37%) is still given without consent, with 18% of Trusts non-compliant with legislation concerning second opinions. There were slight declines, compared to a previous audit, in the use of standardized depression scales, down to 30%, and standardized measures of cognitive dysfunction, down to 24%. Only six Trusts provided any data for positive outcomes and seven for adverse effects. None provided data on efficacy or adverse effects beyond the end of treatment. Twelve Trusts used identical sentences to each other, verbatim, in response to one or more questions.Conclusions. Given the apparent failure of current monitoring and accrediting of ECT clinics in England, by the Royal College of Psychiatrists' ECT Accreditation Service (ECTAS), an independent government sponsored review is urgently needed.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

How Accurate Are ECT Patient Information Leaflets Provided by Mental Health Services in England and the Royal College of Psychiatrists? An Independent Audit

“…ECT is still used on about 2,500 people a year in England, predominantly women over 60 (Buley et al, 2017;Read et al, 2018;Read et al, 2021). But the information leaflets given to patients considering ECT and their families is almost always limited, and is frequently misleading.…”

“…About 37% of people given ECT in England are forced to have it against their will, that is, without giving consent; with some Trusts reporting rates above 70% (Read et al, 2018;Read et al, 2021).…”

“…In the second audit (Read et al, 2021) only one Trust could answer the question. This lack of interest by service providers is reinforced by the RCPsych's ECTAS.…”

“…We have previously reported that a total of 12 Trusts used replicated, identical (verbatim) statements like this to respond to several of the other questions in our FoI request (Read et al, 2021). When asked to explain this use of identical phrases, some Trusts denied that the statements were copied from, or influenced by, any external organization.…”

A response to yet another defence of ECT in the absence of robust efficacy and safety evidence

“…This item assessed whether the studies' samples represented the demographics of people who actually receive ECT today and, therefore, whether their findings are meaningful. In England, for example, twice as many women as men are given ECT, and most ECT recipients are over 60 years old (Read et al, 2018 ; Read et al ., 2021 b ). The definition of the criterion (which was explicitly stated) was rather generous: ‘More than 50% female (but not all), and mean age of 50 or more.’ Meechan et al .…”