Written question WQ83460

I understand the concerns expressed by mental health charities in Wales about the use of Electroconvulsive Therapy (ECT).

The National Institute for Health and Care Excellence (NICE) has published professional and clinical guidance for the NHS, which must be followed if ECT is given. It states ECT should only be used to “achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening”. I attach a link to the summary leaflet by NICE on ECT at: http://guidance.nice.org.uk/TA59/PublicInfo/pdf/English

There are robust safeguards in place for patients relating to the use of ECT. ECT cannot be used, apart from in emergencies and in the circumstances described below, unless a person agrees. Before a course of ECT begins, patients should be provided with comprehensive information about the nature of the treatment, any side effects or risks involved, clarity about how the treatment will be given and alternative treatments - including information and risks of having no treatment at all.

If a person lacks capacity for any reason, all the safeguards of the Mental Health Act 1983 apply and an independent Second Opinion Approved Doctor (SOAD) must agree ECT is the right treatment. In addition, a SOAD must agree before any patient under 18 can be given ECT, even if they have capacity and have consented to the treatment. Further details on the use of ECT can be found on pages 104, 105 and 109 of the Code of Practice to the Mental Health Act 1983. This document is available online at http://www.wales.nhs.uk/sites3/page.cfm?orgid=816&pid=33960.

The Independent Review of the Mental Health Act 1983, chaired by Sir Simon Wessely, proposed further safeguards in respect of ECT. Proposals around increased safeguards in relation to the most invasive treatments were included in the UK Government White Paper consultation, published as a response to the Wessely review. Consultation responses to that consultation raised concerns about potentially negative, unintended consequences on both arguments, as well as practical considerations associated with implementing this new safeguard.

The UK Government has proposed further work with stakeholders to explore how these concerns can be mitigated. The Welsh Government is working closely with the UK Government to ensure that a Welsh perspective is considered and any changes to legislation reflect both reserved and devolved policy proposals for the Mental Health Act provisions, as well as strengthening safeguards for patients.