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Mental Health Bill [HL]

ECT is not getting a very good press here tonight. So, while strongly supporting these amendments, I would like to bring us back to some practical science and what we know about ECT. It is true that ECT has been grossly misused in the past. I remember going to see the film ““One Flew Over The Cuckoo’s Nest””, turning to my husband afterwards and saying, ““Goodness me, we never use ECT like that””. The following week, the 10-year review inquiring into St. Augustine’s came out. It described ECT being used in exactly that way. It was deeply shocking for me as a trainee at that time. It is also true that ECT has been used much less often in the past 20 years. It is good to see how little it is used now in most services. But the evidence is that for people with profound depressive, biological types of illness—particularly those in later life, over the age of 60—those illnesses are life-threatening. People die of depression. The mortality rate among those in a depressive stupor is quite high. If you have seen someone near death because they stopped eating and drinking get a little toehold on life again, to enable you to give them the intravenous medications which might enable them to respond over a longer period to medicine, it is very difficult to say, ““I will never give that treatment again””. Unfortunately, it is also true that many of those who do respond relapse within three or four months. But although that sometimes happens, ECT is sometimes the only option that one can think of. Nevertheless, as other noble Lords said, we recognise the deep fear, anxiety and revulsion that this treatment creates in many patients’ minds. It seems essential that people should be able to refuse it when they have full capacity. As for emergency ECT under Section 62, only very rarely does it seem necessary to give such treatment. I am rather sceptical about it. Someone would have to be profoundly dehydrated to warrant it, and ECT would be a long shot. One would not be able to wait until Monday or a second-opinion doctor was available. I cannot envisage a scenario where a fully capacitated patient who was able to consent would fall into the need for urgent treatment. So this amendment does ensure that a person with capacity who does not consent should not be subject to ECT in emergencies. I know that Mind has been pressing for a total ban on ECT in children. I say to the noble Lord, Lord Bragg, that initially I was very sympathetic with the idea of tabling an amendment to that effect. Several US states have banned it but not for reasons of science. The literature is poor. There are about a dozen cases every year, few international series and no randomised control trials. Again, though, with regard to the sort of young person who is given this treatment, the recent literature shows that in almost all cases the people concerned in administering ECT have gone out of their way to seek second and third opinions and a consensus decision from the clinical team. So in practice such treatment is happening very rarely. However, it may be lifesaving for a child who is seriously ill and in a depressive catatonic stupor, which is a very rare occurrence. NICE considered the options carefully and, on balance, decided that it was not wise to ban the treatment if perhaps one child’s life could be saved by it. The extra safeguards therefore seem to be the way forward. ECT is always a last resort. I personally would not want to ban it if it saved one child from that appalling condition, depressive stupor. I give my full support to these amendments. We have come a long way, but let us not forget that just occasionally patients ask for ECT because it helped them the last time they had a depressive illness. When it is feared and not sought and the patient has no capacity, however, the treatment should not go ahead.