Concern over variations in use of electroshock treatment

Psychiatric patients are four times more likely to receive controversial electroshock treatment in some health board areas than in others, new figures show. Carl O'Brien, Social Affairs Correspondent, reports.

The findings have raised concern that proper procedures are not being used for a treatment which critics have denounced as barbaric, but advocates regard as highly effective when used correctly.

The chairman of the Mental Health Commission, the State body responsible for upholding high standards in the mental health sector, told The Irish Times the figures were "disturbing" and the reasons behind the disparities would be investigated.

Under electro convulsive therapy (ECT), an electric charge is passed through the brain of patients typically suffering from depression.

The resulting seizure can have a beneficial and rapid effect, though precisely why is unclear. However, some patients complain of side effects including long-term memory loss.

Latest official figures from the Health Research Board show 859 patients received ECT in 2003. While use of the treatment has been declining in recent years, there were dramatic differences in the frequency of its use between services.

In the South-Eastern Health Board, 38.7 patients per 100,000 population received ECT compared to 8.4 in the Southern Health Board.

The Mental Health Commission's chairman, Dr John Owens, said the figures should be examined further. "For a procedure subject to strict protocols, it is difficult to understand why there is such a variation. The figures suggest a practice more based on the person prescribing it rather than clinical guidelines. That is of concern," he said.

The highest rate of use as a per cent of overall admissions was recorded in Dublin's Vergemont Clinic, Clonskeagh (14.8 per cent), followed by Naas General Hospital (12.5 per cent), St Brigid's, Ballinasloe (8.4 per cent) and Waterford Regional Hospital (7.5 per cent).

While a number of hospitals have either discontinued offering ECT, others offer the treatment more sparingly including Tralee General Hospital (0.2 per cent), St Stephen's Hospital, Cork (0.8 per cent) and St Brendan's Hospital, Dublin (1.2 per cent).

Britain's National Institute for Clinical Excellence (NICE) recently recommended limiting its use, partly because of the inadequacy of research into the effects of ECT.

The Irish College of Psychiatrists said it was reviewing the figures.

Dr Owens said there was still a role for ECT where other approaches had failed. However patients had to be kept fully informed about the procedure and its effects, he said.

Doctors differ on benefits of shock treatment: page 6