Forced Electroshock in Australia
Source: The Age, Victoria, Australia
Mental health care inquiry
PREMIER Ted Baillieu last night ordered a wide-ranging inquiry into dozens of patient deaths inside Victoria’s mental health system.
The inquiry follows a report in The Saturday Age exposing the high rates of unexpected and unnatural deaths in the state’s mental health wards, and raising serious questions about standards of care and allegations of cover-ups.
Today, The Age publishes new revelations about the use of electric shock therapy in Victoria, with documents showing how hundreds of mentally ill people are forced to undergo the procedure without their consent.
Mr Baillieu’s office last night announced that the state’s Chief Psychiatrist, Ruth Vine, would investigate the way the state’s health services handled all unexpected, unnatural or violent deaths involving mental health inpatients between January 2008 and December 2010.
The investigation follows The Saturday Age’s revelation that 36 Victorians had died in mental health wards during that period.
Dr Vine will examine each hospital internal inquiry into the deaths and whether all recommendations for improvements by health services or the Coroner were acted on or ignored.
”The Chief Psychiatrist will report back the findings of these investigations to the Minister for Mental Health by the end of 2011,” a statement from the Premier’s office said.
The Age was yesterday inundated with responses and information from Victorians regarding their concerns about the state of the public mental health system.
The inquiry comes as The Age has learnt that hundreds of mentally ill Victorians forced to undergo electric shock therapy without their consent are being given far more sessions of the controversial treatment than those who choose it voluntarily.
In 2009-10, 1111 Victorians received electroconvulsive therapy, a procedure that induces seizures by delivering an electric current to the brain, in the public mental health system.
Of these, 377 – or about one third – were deemed involuntary patients who did not consent to the treatment commonly known as ECT.
Documents obtained under the Freedom of Information Act show involuntary mental health patients received more than half of the 12,968 ECT sessions administered in the public psychiatric system last year.
Victoria is the only jurisdiction in Australia that allows treating psychiatrists to administer ECT without consent or external review.
ECT remains one of the most divisive and controversial treatments in psychiatric care. Proponents argue that it is an effective way to fight depression and a safe alternative to drugs that have dangerous side effects. Critics claim ECT causes memory loss, headaches and confusion.
Victoria’s Mental Health Minister, Mary Wooldridge, last night told The Age that new mental health laws would be introduced ”to put in place better safeguards and clinical checks to ensure appropriate use” of electro-convulsive therapy.
Victoria’s Mental Health Legal Centre said new laws were needed to better protect mental health patients and to ensure nobody was forced to undergo procedures such as ECT against their will.
“The Mental Health Legal Centre is of the view that ECT should only be performed with the full, free and informed consent of the person,” said the centre’s lawyer, Catherine Leslie.
”Involuntary ECT is a serious infringement on a person’s human rights.”
The use of ECT in Victoria’s public and private psychiatric services has increased sharply in recent years.
In public mental health services, its use has increased by 12 per cent since 2003 to 2004, according to Department of Health figures.
Private ECT sessions in Victoria have increased by 71 per cent during the same period, Medicare figures released to The Age show. Medicare allows psychiatrists to claim about $67.00 for each ECT treatment. About 640 people received ECT as private patients in 2009-10.
Dr Vine recently attributed the rise in private ECT treatments to an increase in psychiatric beds in the private sector and more patients choosing to use the procedure to combat depression. Dr Vine said ECT was a safe and effective form of treatment.
”The biggest issue (with ECT) I have to say is the difficulty we have in shaking community perception about this being in some way negative when for many people it is a very effective treatment,” she told The Age.
”As a treating doctor, to see someone with a really severe melancholic depression who is absolutely convinced that they’re riddled with guilt and should be dead, to see that just melt away with a reasonably short course of ECT, it is one of the miracle treatments.”
But a recent international review of ECT cases by psychologists found the treatment may cause permanent brain damage and long-term memory loss.
The study’s lead author, John Read, of the University of Auckland, examined placebo-controlled studies and concluded shock therapy had minimal effects for people with depression and schizophrenia.
The review, published in the journal Epidemiologia e Psichiatra Sociale last year, found almost all ECT patients suffered some amnesia. ”For a proportion of those people some of that memory loss is recouped over time,” Associate Professor Read said.
”However, we are now seeing that for a significant proportion of people that brain dysfunction is permanent. ECT can, for a minority of people, produce some very short-term benefits; it can lift people’s mood quite quickly.”
Professor Read said Victoria’s rate of involuntary psychiatric patients was about double that of New Zealand’s. He supported calls for Victoria to introduce laws to give involuntary patients a greater say in their treatment.
”Mental health is the only area of medicine where you can be forced to receive a treatment against your will. It borders on discrimination, I’m talking about medication as well,” Professor Read said.