Mental health charity Mind is acting today to spark fresh debate about electro-convulsive therapy (ECT) before the passing of new legislation on treatment of mental illness. The charity claims to have evidence that the controversial practice is used indiscriminately, without proper consent, and often leads to devastating after-effects.
While ECT is seen by some as a lifesaver, a survey of Mind supporters suggests that two in three of those who have received it would not agree to it again. More than half were not aware that they could refuse consent to the treatment, by which patients are given an electric shock to cause a therapeutic seizure.
The findings are based on the experiences of 418 patients who have received ECT. To many lay people, the idea of pumping up to 400 volts into the brain of someone who is mentally ill seems barbaric - an impression confirmed by the film One Flew Over the Cuckoo's Nest, when Jack Nicholson is forcibly treated by uncaring staff.
But such images are a "travesty of the truth", according to the Royal College of Psychiatrists (RCP), although it has previously warned that ECT has been administered by inadequately trained staff, without enough supervision and sometimes with out-of-date equipment. Use of the procedure has been declining since the 1950s - it is banned in some countries - but the Department of Health's own figures show that 1,300 treatments are still carried out each week in England.
The RCP maintains it is "one of the most effective treatments we have". Unlike anti-depressants, which take time to work, it has an immediate effect and is particularly useful where a depressed person has been refusing food and drink and is at risk of kidney failure.
Many of the respondents to the Mind survey, however, would argue that the price they have to pay is too high. In Shock Treatment, a report of the survey, they describe how their lives have become broken and fragmented after courses of ECT - with 40% reporting permanent loss of past memories, and 36% having difficulty concentrating. Almost three-quarters of the total sample, and two-thirds of those given ECT most recently, said they were not given any information about possible side-effects.
Margaret Pedler, head of policy development at Mind and author of the report, says that as well as memory loss, some people who had had ECT were left unable to concentrate, read, write or play musical instruments. One woman, from Staffordshire, said: "Most upsetting was that I could not remember the birth of my daughter or anything about her first year."
One man, from Derbyshire, who has had more than 10 courses of ECT treatment in the last 45 years, says he still forgets family members' names. He describes the treatment as humiliating. "I was sexually abused when I was a boy, and suffered severe depression ever since. I think I should have been given counselling. Instead, I just feel as if I'm being punished all the time."
The survey does, however, show how some people have been helped by ECT. One woman, from Hertfordshire, says: "The effect of the treatment was amazing. All psychotic thoughts diminished and I started to feel as if I was finally being lifted from the big black hole I had been in."
While Mind accepts that the treatment does work in some cases, it wants patients to have access to independent advocates and an information leaflet giving full information of side-effects. Patients should also be able to sign advance directives saying they do not want ECT, should they be detained under the Mental Health Act.
Pedler says: "It is clear that people are still not given enough information about temporary and permanent side-effects, and this means that those who are giving their consent are not doing so out of informed choice. No one who is capable of giving informed consent should have ECT against their will. "
The RCP maintains there are already stringent safeguards over the use of ECT and strict procedures governing when it may be given without consent. Geoff Searle, a spokesman for the college, says Mind's survey is biased and cannot be taken seriously. There is, he argues, no scientific evidence that ECT causes permanent damage - long-term memory loss being a feature of depression, irrespective of the treatment.
"People must not lose sight that ECT is an effective treatment when used at the right time and in the right way," says Searle. "We do not understand how it works, but it saves lives."
Shock Treatment is available, at £5 inc, from Mind, 15-19 Broadway, London E15 4BQ (020-8519 2122).
