Clinicians want shock treatment restrictions

A group of mental health clinicians wants Parliament to ban the use of "ineffective and dangerous" electric-shock treatment on young people, pregnant women and the elderly.

The group, comprising two doctors and two clinical psychologists, yesterday addressed the health select committee on a petition signed by more than 2000 people backing a partial ban on electro-convulsive therapy (ECT).

This marks a second bid for MPs to restrict ECT, a treatment many psychiatrists maintain is safe and effective for some severe mental conditions, but which opponents assert can cause brain damage and permanent memory loss.

An earlier petition organised by a patient rights group sought an outright ban. Acting on the committee's recommendations following that petition, the Health Ministry commissioned a review of ECT, which said in 2004 that despite "problems" with the evidence for ECT, its risks were low although greater emphasis should be put on gaining patients' consent.

The GP who began yesterday's petition, Dr Helen Smith, a member of the anti-psychiatry group Citizens Commission on Human Rights, said that because of the lack of evidence supporting ECT, its use should be banned in "the more vulnerable groups" - children, adolescents, pregnant women and the elderly".

Auckland University senior lecturer Dr John Read, a clinical psychologist, said it was hard to set age cut-offs for a ban.

Some studies suggested ECT accelerated dementia in some old people. Brain damage and memory loss was a risk in all age groups, but seemed to increase with age.

He cited a 2003 review in the British Medical Journal of ECT studies which found the rate of reported persistent memory loss was between 29 per cent and 55 per cent.

Dr Thom Rudegeair, clinical director of the acute mental health unit beside Auckland City Hospital, said it had given ECT to just five in-patients in the past three years. In his 15 years as a consultant psychiatrist, he had prescribed it for only six people.

He had seen dramatic short-term benefits following ECT in patients so unwell they could not eat, drink or swallow pills. It gave an opportunity to start more benign treatments.

But it should be banned for pregnant women for whom there were alternatives, because of a lack of evidence about the effects of repeated general anaesthesia - used with ECT - on the foetus.

And it should not be given to children as it affects the developing brain.

The College of Psychiatrists said no data was held on pregnant women given ECT, but children did not appear to have been harmed. ECT was given to adolescents very rarely and to children extremely rarely.


The therapy

* 3170 doses of electro-convulsive therapy were given to 305 patients in 2003/04.
* 691 of those doses (22 per cent) were given as part of compulsory treatment or without the patients' consent.
* Huge regional variations existed. Otago District Health Board, the highest user, gave ECT to 39 patients.
* Auckland DHB gave it to seven.
Source: Ministry of Health

- Additional reporting NZPA