Full compliance with ECT guidelines in Irish mental health centres, report finds

A total of 2,281 individual treatments of electroconvulsive therapy were administered in 2021

There was full compliance with the rules and codes of practice governing electroconvulsive therapy (ECT) in Irish mental health services as the numbers receiving the treatment fell slightly year on year, the Mental Health Commission has revealed.

According to the Mental Health Commission’s recent report on the treatment, the number of people undergoing ECT in Irish mental health centres fell from 239 in 2020 to 219 in 2021, with the number of ECT programmes dropping from 300 to 293 over the same period.

The report, entitled The Administration of Electro-convulsive Therapy in Approved Centres: Activity Report 2021, found there were a total of 2,281 individual treatments of ECT administered in 2021, down 2% compared to 2020, when 2,329 individual treatments were administered.

The Director of Regulation for the Mental Health Commission, Gary Kiernan, said the report provides information on how often ECT is used, the people who receive it, the services providing it, and the quality and safety of the service.

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“The purpose of publishing this report is to provide an assurance to the public that this medical procedure is regulated and monitored by the Mental Health Commission,” said Mr Kiernan, adding it was the 12th such report on ECT published by the MHC.

“Transparency about levels of compliance with the rules and codes of practice governing the administration of ECT is critical. This year it is encouraging to report that there has been 100% compliance with the regulatory requirements for administering the treatment.”

ECT is a medical procedure whereby a patient is placed under general anaesthetic and an electric current is passed briefly through the brain via electrodes applied to the scalp to induce generalised seizure activity with the aim of treating specific types of mental illnesses.

Mr Kiernan explained that a programme of ECT refers to no more than 12 treatments of ECT prescribed by a consultant psychiatrist, with the total number of treatments administered in a programme of ECT varying from one to 12 treatments.

The report shows that a majority of residents — 74pc in 2021 and 70pc in 2020 — were administered one programme of ECT and that all relevant services (100%) were compliant with the Code of Practice on the Use of ECT in 2021, an increase from 86% compliance in 2020.

According to the report, mood disorders, including depression, were reported as a diagnosis for 87% of residents who were administered ECT in 2021, compared to a figure of 80% of residents who were administered ECT in 2020.

Resistance to medication was the most common single indication for ECT, accounting for 62% of programmes (181) in 2021, and 64% (193) in 2020. Improvement was reported as the outcome in 87% of programmes of ECT (256) in 2021, compared to 63% in 2020 (189).

According to the report, the average age of all residents who were administered ECT in 2021 was 65 years, an increase from an average of 62 years in 2020. In 2021, residents receiving ECT ranged in age from 23 to 94 years, compared to 25 to 93 years in 2020.

Data from recent years indicate female residents are more likely to be administered ECT than males. This was also evident in 2021, when 59pc of recipients were female and 41pc were male. This may reflect the relatively higher incidence of depressive illness in women as compared with men.

According to the report, in 2021, 87% of ECT treatments (1,985) were administered with consent, and 13% (296) were administered without consent compared to 81% of treatments (1,881) with consent in 2020, and 19% of treatments (442) without consent.

In 2021, 15% of ECT programmes (43) involved one or more treatments without consent, compared to 19% (59) in 2020. MHC rules governing the use of ECT therapy address the issue of consent to treatment and provide a series of safeguards for situations where a patient is unable to consent.

Barry Roche

Barry Roche

Barry Roche is Southern Correspondent of The Irish Times