ECT and suicide in England

I came across an article published in 2010 and entitled ‘Electroconvulsive therapy and suicide among the mentally ill in England: A national clinical survey’ by researchers at Manchester University reporting on research that was carried out as part of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness.

I found the following extracts from the article particularly thought provoking- I have highlighted and commented on the phrases of particular interest for me:

‘Electroconvulsive therapy (ECT) is considered an effective short-term treatment for patients with severe depressive illness (UK ECT Group, 2003). It is usually an end-stage therapy, recommended for those who have not responded to other therapies and whose severity of illness may be life-threatening (National Institute for Health and Clinical Excellence, 2003). However, guidelines of the American Psychiatric Association task force state that ECT should not be reserved for use as a “last resort” but promotes its use as a first-line treatment when there is a need for a prompt and definitive response, when patients have responded well to previous ECT administrations, and when the treatment is preferred by the patient (Task Force on Electroconvulsive Therapy, 2001)’. (p.145) 

I am wondering whether the phrase  ‘recommended for those who have not responded to other therapies’ may need to read ‘recommended for those who have not responded to drug therapies’. It was suggested that I was given ECT when I was very ill back in 2009/2010 as ‘no other treatments had worked’ and my severe and enduring  depression was ‘treatment-resistant’. What that really meant though is that  drug treatments had not worked,as I had only been offered drug treatments. My depression may not have been so resistant to talking therapy (psychotherapy treatment) but that was never on offer within NHS mental health services until I personally asked and insisted to be referred to a psychologist when I was discharged from hospital and I was under the care of a Community Mental Health Team…

‘In England, there has been a reduction in the use of ECT over the past few decades. In 1999, 2835 patients received ECT over a 3-month period, equating to an annual estimated total of 11,340 patients (Department of Health (DoH), 1999). By 2002, this annual figure had dropped to an estimated 9088 patients (DoH, 2003). These figures may be underestimates, however, as administration of ECT may not always be documented and there has been no formal national monitoring of ECT activity in the UK (DoH, 2003). A more recent study in 2006 confirmed a further decline in ECT administrations overall, although reported an increase in the proportion of patients receiving ECT who had been detained under the Mental Health Act (Bickerton et al., 2009)’. (p. 145) 

‘The impact of ECT on completed suicide, however, is less clear, particularly as the proportion of those who die by suicide who have received ECT is very low‘. (p.145) 

Suicides following ECT may be an indication of treatment failure’. (p.146) 

 ‘Estimates of suicide risk in our study were more often viewed by clinicians as moderate or high in patients who had received ECT. Clinicians were also more likely to view ECT suicides as preventable. The most common factors that clinicians suggested could have made the suicide less likely were closer patient supervision (n=34, 50%), better staff training (n=13, 19%) and improved staff communication (n=13, 19%; Fig. 1)’. (p.147)

‘Patients in out study  who had received ECT and died by suicide were older than other suicide cases, the majority were suffering from affective disorder and rates of previous self-harm were high. They were proportionally more likely to be an in-patient at the time of death or die within three months of discharge. However, they were no more likely to be under enhanced observation. Clinicians more often viewed ECT cases as at high risk of suicide and as more preventable’. (p.147)

 

You can download the entire article here ECT and suicide (1)

 

 

  • reply an ,

    Hi Dina

    Don’t know if you have an age profile of people being given ECT? I seem to recall that the elderly people form the largest group. if so, this is worrying?

    • reply Dina ,

      Hi, Anne. thanks for this.

      I had a look at a DoH publication (Electro Convulsive Therapy: Survey covering the period from January 2002 to March 2002, England) where it is stated that 47% of female patients and 45% of male patients receiving ECT treatment were aged 65 and over, so I assume that elderly people are likely to form the largest group. This is what the paper attached to the post ‘ECT and suicide in England’ also indicates (the people who killed themselves following ECT treatment were likely to be older).
      I imagine administration of ECT to elderly people suffering mental distress raises important issues of capacity and ability to consent to treatment; these issues are there of course for younger people in distress but for the elderly are more augmented. I fear that elderly people are more likely to be given ECT ‘in their best interests’ (with the use of the mental capacity act) when their capacity to consent is deemed diminished. Interestingly, according to the DoH publication mentioned above, of the 600 patients formally detained receiving ECT treatment, 60% did not consent to treatment. I am wondering how many of these people (the 60% not consenting to treatment) were elderly with ‘no capacity to consent’, receiving ECT ‘in their best interests’. So, because of the issues of capacity and consent to treatment, administration of ECT largely to elderly people IS worrying.

      what do you think?
      Dina

    • reply an ,

      Hi Dina

      The previous government in their Consultation on the reform of the Mental Health Act 1983 (DoH 1999) gave an example of “How the Compulsory Order might Work
      “Mrs O is a 79 year woman. She lives in Part 3 accomodation (sheltered housing?). Her memory is deteriorating slightly but she has been well-settled in the accomadion. Over the past few weeks she has become agigitated, depressed and has adamantly refused the medication her GP has offered her. The old age psychiatric team has been called in …(p39).

      I think this is an appalling use of power. Initially being settled is no guarantee that things will stay the same , either in the personal life of this woman (family relationships, for example) or in the staff or way the Part 3 accomodation is managed or for some other external reason.

      I wrote in an article (a review of Liz Sayce’s From Patient to Citizen: Overcoming Discrimination and Social Exclusion 2002)
      “Attributing distress of elderly people to some sudden onsets of ‘mental illness’ in these circumstances could surely open doors to institutional abuse.” Interestingly, one of the peer reviewers wanted this example removing(I ignored it)!

      I have lived in a cul de sac of bungalows, largely for elderly people, for the many years because my late partner ken was disabled. For a period , probably the 80s, quite a lot improved for elderly people but their situations are becoming increasingly dire. All kinds of services have gone from home helps who had an hour to clean and chat to their service users , to regular grass cutting and local ‘luncheon clubs’ as cash payments are made instead – much of this goes to ‘care agencies’ who start their ‘assisting to bed routines’ on our estate which means bed at 7.30pm and 20minutes is allowed in the morning to help people up, wash and have breakfast prepared. Meals on wheels, although it had its limitations, has been replaced with a microwave and a delivery of frozen food every fortnight. Quite a lot to get upset about?

      x Anne

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