Greater Manchester Mental Health Trust uses Electro-convulsive Therapy at one of highest levels in country: We call for review

We call on Greater Manchester Mental Health Commissioners to urgently review this treatment and provide alternative support for people previously administered ECT.

We call on GMMHT to suspend the treatment and to explain the huge difference in usage compared with our neighbouring Trust, Mersey Care.

We call on on the Mayor of Greater Manchester to call a halt to this practice and to support the national campaign for a review of ECT

CHARM Communities for Holistic Accessible Rights based Mental Health

Findings from an audit published last week shows that Manchester has the 4th highest rate per capita for administering electroconvulsive shocks in the country.

This shocking statistic means Manchester’s rate of administering ECT is 8.7 per 100,000. This is way above the national average of 5.4.

This is 43 times greater than the lowest Trust, our neighbouring Trust, MerseyCare.

Or to put it another way, for every one person receiving ECT in Liverpool, 43 people receive it in Greater Manchester.

ECT involves an electrical current being passed through the brain under anaesthetic to trigger seizures. Mostly administered to older women. The Greater Manchester Mental Health Trust claims Electroconvulsive Therapy is an effective and essential treatment and they plan to further develop this service in the new Park House Psychiatric Hospital in North Manchester.

The audit throws considerable doubt on the wisdom of this decision. In 2019 the authors of the ECT audit contacted 56 Mental Health trusts in England (using Freedom of Information Act requests) and asked whether they were following NICE guidelines about ECT being a treatment of last resort. They were also asked about other things such as how they were monitoring for signs of progress, brain damage and cognitive dysfunction. 57% of NHS Trusts replied.

The audit discovered ECT is a dwindling treatment. However, it also found that there is a 47-fold difference between the Trusts with the highest and lowest usage rates per capita and the highest rates of usage are in the North West of England.

The research has also revealed that there is no regulatory authority responsible for ECT safety and monitoring its appropriate use.

We know GMMHT responded to this Freedom of Information request, even though their answers were incomplete. What we have subsequently found out about this practice in Greater Manchester has increased our concern. (you can see their position in the notes below). We’ve also discovered there is no information about ECT services on their website.

In our view ECT is a controversial psychiatric treatment for depression and other conditions because it can cause side effects such as memory loss and is ineffective for many patients.

Further, a range of respected organisations are calling for a review because of safety concerns, asking for national audits to be reinstated and for independent, objective monitoring of adverse effects to be put in place, including: National Mind, Headway, Association of Clinical Psychologists, PsychSoc, Change Wales, Platfform (formerly Gofal, Wales), the National Counselling Society, the National Hearing Voices Network in England, and the Royal College of Nursing.

We have been calling for the adoption of new approaches in line with the GMMHT’s philosophy of care, based on recovery, psychologically informed environments, and a trauma-informed approach.

ECT does not fit within this approach. It should be dropped now and the funding and staffing used for more compassionate and appropriate evidence based support.

In conclusion we demand:

  • the Mental Health Commissioners urgently review this treatment in light of the anomalies re. over use of ECT by GMMHT
  • that GMMHT, explain the huge difference in usage compared with our neighbouring Trust, Mersey Care
  • the provision of alternative support for people previously treated using ECT and ultimately to suspend the use of this treatment
  • the Mayor of Greater Manchester calls a halt to this practice and supports the national campaign for a review of ECT
Notes:

Campaign News

Questions have been asked about the apparent  failures in ECT practice in Parliament by Dr Rosena Allin-Khan, Shadow Minister for Mental Health and more than 20 MPs have also expressed support for the campaign in various ways including asking Matt Hancock to set up an independent review. In Greater Manchester, Jim McMahon, MP for Oldham West, has agreed to request a Westminster Hall debate on ECT and we have written to Jeff Smith MP asking him to support this request.

We would encourage you to write to your MP (see link to the letter to Matt Hancock here or use the template which can be found here)

See more from the ECT Campaign Blog here

Practitioner points: 

  • Psychologists and other mental health staff should ensure that people are offered evidence-based psychological treatments before being offered E.C.T.
  • All staff should ensure that patients are fully informed of the high risk of memory loss and the smaller risk of cardiovascular failure and mortality.
  • Individuals receiving ECT should be closely monitored for adverse cognitive effects, and treatment immediately terminated if these become apparent.
  • Because of increased risk of memory loss for women and older people, the use of ECT should be kept to a minimum and avoided where possible, with these two groups.

GMMHT’s Freedom of Information response from February 2020 to questions about use of ECT here.

They do not answer any of the questions, instead refer to the answers contained within GMMHT’s Freedom of Information response from September 2018 to questions about use of ECT here.

However they only partially answered the questions put to them, for example claiming they could not provide information about the cost of the ECT service as this is commercially protected information. However we’ve discovered that in 2009 six treatment sessions of ECT were estimated to cost £2475. This does not include inpatient costs, estimated as £171 per day. (Nice ECT Operational Guidance 2009.) If the 104 patients treated with ECT had 6 sessions, the annual cost would be about £250,000.

In the most recent audit GMMH said they had treated 104 patients in 2019 and answered two other questions:

What measures of clinical outcome were used for patients who received ECT and what were the results?

They answered: Patient self-report, MADRAS, CGI, other tailored outcome measures as appropriate.

What measures of adverse effects for patients who received ECT were used, and whatwere the results?

They answered: Patients have a structured assessment of physical and cognitive side effects (including self-report and observed symptoms) which includes appropriately tailored standardised cognitive assessments. The results of these tests/assessments are used to guide treatment decisions with patients.

They said they could not answer any other questions, not even gender or how many patients were under 18 / over 60, or how many without treated without consent.

The reason they gave was ‘This data is not centrally collected’ and it would take too long to go through all the files.

That is probably true but the fact that they don’t collect data (including whether it works and whether it causes memory loss etc) speaks volumes about what the Trust thinks is important.

See GMMHT’s Electro Convulsive Therapy Policy here. It was due to be reviewed in 2020, there is no sign that it has been, we have asked for information about this from the Trust.

In GMMHT’s Description of ECT service taken from GMMHT Clinical Model for Inpatient Care document for the proposed new Park House Psychiatric Hospital (pages 26/27) they make claims for the treatment that we would challenge:

Description of ECT service taken from GMMHT Clinical Model for Inpatient Care for Park House Hospital here (pages 26/27)

Extracts

They say: “Electroconvulsive Therapy (ECT) is an essential intervention for some service users who attend treatment from both the inpatient wards and community settings. ECT can be a life-saving treatment for some and is the definitive treatment for catatonia of any cause and life-threatening depression.”

We say:

  • The use of ECT in is dwindling in England and has levelled off at about 2,500 people per year.
  • There was a 47-fold difference between the Trusts with the highest and lowest usage rates per capita.
  • 27% of the people who were given ECT in 2015 were not offered any psychological therapy before getting ECT.
  • People administered ECT are mostly women (66%) and people over 60 (56%) (a Department of Health study in 2003 found that 70% of those receiving ECT are female).

They say: “The possibility of receiving ECT can be frightening, and service users should receive information on the pros and cons of this treatment, and have the opportunity to discuss these in full with the clinical team.”

We say:

  • More than a third of ECT was given without consent, and 18% of Trusts were non-compliant with legislation concerning second opinions.
  • Only one Trust could report how many people received psychological therapy prior to ECT, as required by government guidelines.
  • Only six Trusts provided any data for positive outcomes and seven for adverse effects. None provided data on efficacy or adverse effects beyond the end of treatment
  • In 2018, a class action case was settled in the US after a federal court ruled that a reasonable jury could find against manufacturers of ECT equipment if they failed to warn of the dangers of brain damage.
  • One ECT manufacturer, Somatics, immediately added “permanent brain damage” to the list of risks from the treatment”.
  • Thymatron ECT manufacturers are required to note that ‘the long term safety and effectiveness of ECT treatment has not been demonstrated’ and to warn of ‘permanent brain damage’ as a possible consequence.
  • GMMH has been using the Thymatron System IV, from 1st January 2017

Articles

The audit summarised findings here: https://www.psychologytoday.com/gb/blog/psychiatry-through-the-looking-glass/202103/report-finds-monitoring-electroshock-treatment

Summary of ECT practice in Aeon online journal: https://aeon.co/essays/why-is-electroshock-therapy-still-a-mainstay-of-psychiatry

Lack of evidence for ECT in Psychology Today: https://www.psychologytoday.com/gb/blog/psychiatry-through-the-looking-glass/202008/80-years-do-we-know-if-electroconvulsive-therapy

Article about the debate in Medscape:  https://www.medscape.com/viewarticle/934536

‘ECT – from research to action’ Psychology Today https://www.psychologytoday.com/gb/blog/psychiatry-through-the-looking-glass/202008/electroshock-therapy-research-action

Psychology Today: Comparing the evidence for ECT to that for homeopathy: https://www.psychologytoday.com/gb/blog/our-turbulent-minds/202009/should-ect-be-judged-the-standards-homeopathy

JohnRead Interview interviewed about the campaign by Lucy Johnston: https://www.youtube.com/watch?v=_gFQ3p2dVRw&t=855s

COMING SHORTLY

AN overview of the information in patient ECT leaflets, demonstrating that informed consent is virtually non-existent, since very few are warned about longterm damage, but are instead are told about re-setting the brain mechanisms that cause depression.

The campaign has also attracted interest from a European Mental Health group with links to the European Parliament. 

Published by CHARM Greater Manchester

CHARM, the Community for Holistic, Accessible, Rights Based Mental Health was launched by The Organic Recovery Learning Community in September 2020.

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