---

Mental Health Bill [HL]

moved Amendment No. 17: 17: After Clause 7 , insert the following new Clause— ““ECT compliance with standards After section 63 of the 1983 Act insert— ““63A ECT compliance with standards Electroconvulsive therapy (ECT) shall not be administered except in a service that has been accredited for that purpose by the Royal College of Psychiatrists.”””” The noble Earl said: We come now to an amendment which, I hope, the Government will be sympathetic to. It would ensure that ECT is only delivered in a service that meets acceptable standards. I shall remind noble Lords who may not know that ECT involves giving a patient a general anaesthetic and passing electricity through their head. The purpose is to cause a seizure, which is intended to have anti-depressant effects. In order to have that effect, the dose of electricity must be enough to cause a seizure, but it should exceed that threshold by as little as possible if adverse cognitive effects are to be minimised. A systematic review carried out for the Department of Health stated that the more effective forms of ECT tended to cause more memory impairment. The potential for harm does not relate just to cognitive damage, but to psychological damage as well. ECT, for many people, is frightening and distressing. The fears that people have are unfortunately borne out by the evidence. The noble Lord, Lord Bragg, mentioned the work of Mind, with which I know he is closely involved. A Mind survey, six years ago, of patients’ ECT experiences, found a high level of unwanted side-effects. Of those who had had ECT in the two years prior to the survey, 40 per cent reported permanent loss of past memories; 36 per cent reported difficulties in concentrating; 27 per cent reported an inability to remember new information; and 49 per cent said that they would not agree to have it again. Respondents from black and ethnic minority communities were more likely to have received ECT without consent, and they had a more negative view of it than the overall sample, with 50 per cent finding it unhelpful, damaging, or severely damaging in the short term, and 72 per cent in the long term. It is therefore clear that, if ECT is to be given, it has to be given in line with best practice—not least in the way that information is provided to patients. I did not mention that, in the Mind survey, 34 per cent of respondents said that they were not aware that they could refuse to give consent to the treatment. The information that needs to be promulgated should also be about people’s rights. Despite the hazards associated with ECT, the Mental Health Act does not prevent it being administered in clinics where conditions are unsafe and staff are inadequately trained or supervised. The ECT Accreditation Service (ECTAS) was set up by the Royal College of Psychiatrists in 2003 to improve quality standards. I understand it to be a thorough and soundly based scheme, but it is only voluntary. At October 2005, 78 clinics had joined it, and that is about 40 per cent of ECT clinics in England, Wales and Ireland. I am sure that we should support voluntary engagement in the ECTAS process, but is that enough? I do not think that it is. I really do not think that it is acceptable that people are being given ECT in clinics that have been or would be denied professional accreditation. I say that because the standards involved in accreditation are all to do with safety. The themes that have emerged in the first two years of the scheme’s operation among clinics that did not pass first time include lack of proper risk assessments; lack of trained supervision; absence of essential equipment to monitor the patient’s breathing during anaesthesia; no monitoring of adverse events; and an absence of operating protocols. In other words, a failure to meet standards necessarily indicates that absolutely essential requirements of safety, effectiveness and acceptability have not been met. I do not know—none of us can know—what proportion of clinics that have not yet joined the scheme would fail to get accreditation. According to the royal college, however, the experience to date suggests that, for a clinic that is initially found to be sub-standard, it is not a difficult or expensive matter to bring its services up to scratch. I very much hope, therefore, that the Government will look most carefully and constructively at the proposal in the amendment. I beg to move.