Thousands receiving ECT without consent

Australia Broadcast Center

5 hours ago

Annie Guest: The mental health treatment known as electroconvulsive therapy is often used as a last resort to address severe depression. Last year, more than 1,700 orders for involuntary electroconvulsive therapy or ECT were approved by tribunals across Australia. Some advocates are raising questions over consent but psychiatrists say those receiving mandatory ECT are too unwell to do so. Geraden Cann reports.
Geraden Cann : Rebecca says she remembers fighting her clinical team all the way to the theatre.
'Rebecca': I felt completely helpless, that my body wasn't my own. I felt like I was in a movie.
Geraden Cann : She was about to receive electroconvulsive therapy or ECT.
'Rebecca': I was shocked they could actually administer it against my will.
Geraden Cann : Rebecca, who's not using her real name for this story, had been experiencing delusions when she was voluntarily admitted to hospital. At one point she tried to go on holiday without any tickets or identification, but shortly after admission she was placed under a treatment order and told she would be having ECT. Her case raises the issue of when authorities should and should not be able to give a person ECT without their consent. Health authorities describe ECT as a safe procedure where the patient is under general anaesthetic. Electrodes are placed on the head and seizures are induced in the brain. Colleen Loo is a clinical psychiatrist and a professor at the University of New South Wales. She's also a former president of the International Society for ECT and Neurostimulation. She says for many patients receiving ECT their symptoms are so severe they've lost touch with reality, including those who pose a risk to their own safety.
Colleen Loo: So this person believed that they were in such a terrible state that they lacked internal organs. This was a delusional belief that they had no stomach, no gut, etc. and therefore they could not eat and drink. Now if you continue without eating and drinking you would die in a few days. Medication treatments hadn't worked. It's not a kind of state that you can talk people out of. Talking therapy does not work with delusions. So this person lacked the ability to understand they had an illness.
Geraden Cann : She says that patient was put under the Mental Health Act, treated on an involuntary basis, and was completely well after five or six treatments.
Colleen Loo: So this is an example of someone who was seriously ill so much so that they lost insight into actually having a mental illness, so could not have chosen ECT treatment even though in this case it was a life-saving treatment. And this is not just a one-off case. This person is very typical of the kind of people we treat in public mental health.
Geraden Cann : There are different rules in each state and territory, but most require a tribunal to approve a clinician's request to give a patient involuntary ECT. Those tribunals usually require a patient to be unable to give informed consent and to be admitted to hospital involuntarily. And there's usually a requirement that less restrictive treatments have been tried first. Simon Cotterill is a mental health advocate and has previously been an internal advisor to Victoria's Royal Health Commission into the mental health system. He says while he hasn't represented anyone before the tribunal, he's heard many others describe the process as a rubber-stamping exercise.
Simon Katterl: I spoke to people who gave evidence to the Royal Commission. I supported them to give evidence to the Royal Commission. They said that they felt silenced and that the treating team's perspectives were valued over them and their lawyers. People speak a lot about a lack of procedural fairness, that they're not given information in a timely way, even though that there's obligations under mental health legislation for treating teams to do so.
Geraden Cann : Katterl points to high ECT application approval rates as evidence tribunals too readily agree with clinicians. In the 2023 to 2024 year, the New South Wales Mental Health Review Tribunal approved 95% of the 749 applications for ECT orders. In Queensland, 92% were approved. Colleen Lu says the approval rates are so high because the doctors and tribunals work closely together, paying attention to the same legal criteria.
Colleen Loo: And we've all, when we started off, presented people who we thought needed treatment but the tribunal said, no, we will not approve that. So you learn kind of what is the threshold that the tribunal is likely to approve and we don't present people who are unlikely to meet that threshold.
Annie Guest: Clinical psychiatrist, Colleen Loo, ending that report from Geraden Cann.