ECT.... ammendement to mental health act 2001

firesidechat

Amnesty International are lobbying for change in the mental health act 2001 in regards to the use of ECT therapy by service providers.
The debate is to resume in the oireachtas on march 9 where views from service providers and service users shall be heard.

Section 1 refers to section 58 of the Mental Health Act 2001 which relates to the practise of psychosurgery. In consultations which took place since the previous occasion on which the legislation was debated, the other sponsors of the Bill and I agreed that it needed to be more focused and should concentrate solely on the involuntary use of electroconvulsive therapy. However, we are still of the view that action should be taken to tackle the legislative provision relating to the practise of psycosurgery. This should be done in the context of a future review of the Mental Health Act 2001.
“Psychosurgery” is a more polite medical term for the practise of lobotomy. It has not been practised in this country for more than 30 years and the likelihood is it probably will not be used. We should be unhappy it is provided for in legislation but that is not the focus of the Bill. On those grounds, we propose that section 1 of the amendment Bill be deleted.
The purpose of this debate and the Bill, as we hope to progress it, concerns involuntary treatment and the inconsistencies in how people are treated medically in terms of physical ailments and psychiatrically in terms of mental ailments and the principle of, and the ability to give, consent. It is not an all-embracing attempt to change the legislation. However, it points to one important area. As we move on to the other amendments, it is important to put on record that it is not about removing, in all circumstances, the use of ECT, a controversial treatment, but of minimising its use.
There is an acceptable argument that it has been overused, misused and unfortunately has affected people in a way that may not have been intended. There have been victims of the use of this treatment. We will hear arguments as to how people have been treated successfully owing to the existence of the treatment. In striking the balance between people’s right to their own bodily functions and minds and the need to protect society and administer an appropriate course of medical and psychiatric attention, we can all agree, whatever else we agree about in terms of the general focus of this Bill, that our law is deficient and that the review of the Mental Health Act is overdue and needs to come to a quick conclusion and make appropriate changes in order that the rights of patients, in particular, can be better protected.

What do you think?
Should it be used?
Should the service user have the right to refuse?
Can the opinion of the service user be ignored , and if so who decides to overide that opinion.
If a service user is not capable of making a sound decision on its use , can the service providers make that decision for him/her regardless of how family members may feel .
Who should have the last word on its use , or should it be an option at all?

Odysseus

firesidechat wrote: »

What do you think?
Should it be used?
Should the service user have the right to refuse?
Can the opinion of the service user be ignored , and if so who decides to overide that opinion.
If a service user is not capable of making a sound decision on its use , can the service providers make that decision for him/her regardless of how family members may feel .
Who should have the last word on its use , or should it be an option at all?

My understanding is that as a last resort, it is a useful treatment. I have not enountered any person who has undergone ECT who felt they where abused.

Yes from my understanding gained from patients and psychiatrists it should be used when needed.

If the person is so unwell that they cannot make a valid decision yes, but this decison to override a patients wishes if only made in rare cases to the best of my knowledge. If a person can be given drugs against their will why not another treatment.

Family members are not trained professionals, should they be in the position to override a professionals treatment plan?

My understanding is that it is not over used, out of interest any references for this statement referring to its use in Ireland?

firesidechat

Sorry odysseus, I should have included a link to the opening post.
http://debates.oireachtas.ie/DDebate.aspx?F=SEN20091202.xml&Page=1&Ex=H12#H12

At present i believe all that is needed to overide a service users refusal
to therapy are recromendations from two psychiatrists.

Odysseus

firesidechat wrote: »

Sorry odysseus, I should have included a link to the opening post.
http://debates.oireachtas.ie/DDebate.aspx?F=SEN20091202.xml&Page=1&Ex=H12#H12

At present i believe all that is needed to overide a service users refusal
to therapy are recromendations from two psychiatrists.

I could be wrong be I think one of these needs to be a consultant, from what I know its not a willy nilly decision, it is a very serious one. So I don't believe the overuse, and using language like "all that is needed" undermines the seriousness of it. I know a few psychiatrists who have used this intervention and speaking from the ones I have spoken to about it, it's not a decision made off the cuff. What would you like to see?

firesidechat

It was never my intention to undermine the seriousness of this therapy.
I understand that most,if not all service providers resort to this treatment
only after all other forms of treatment have been exhausted.I would be concerned with the service users right to refuse . If one is not able to make that decision due to illness, maybe family members or carers should have the right to speak for them. We see cases where patients with various forms of cancer (some life threatening) are given a say in what treatment they receive. They have the option to refuse various treatments. Definetly i believe the service user should have some representative who can speak on his/her behalf. If the service user does not wish to undergo such therapy , I believe their wishes should be respected. Now, If the service user has no one who can speak on their behalf, Where do we go from there? Perhaps a review where service providers and service users advocates can state their case and a legal binding decision would be made by an independent party.

Odysseus

firesidechat wrote: »

It was never my intention to undermine the seriousness of this therapy.
I understand that most,if not all service providers resort to this treatment
only after all other forms of treatment have been exhausted.I would be concerned with the service users right to refuse . If one is not able to make that decision due to illness, maybe family members or carers should have the right to speak for them. We see cases where patients with various forms of cancer (some life threatening) are given a say in what treatment they receive. They have the option to refuse various treatments. Definetly i believe the service user should have some representative who can speak on his/her behalf. If the service user does not wish to undergo such therapy , I believe their wishes should be respected. Now, If the service user has no one who can speak on their behalf, Where do we go from there? Perhaps a review where service providers and service users advocates can state their case and a legal binding decision would be made by an independent party.

Fair enough, if I misrepresented you I apologise. I have issues around family members determining treatment though. I work with less severe disorders and tbh family members often push for a treatment format that is not apporpriate that would be my concern.

Family members are not medically or psychologically trained, and though this is not always the case, in some cases they are pushing their own agenda and wishes. THB I have little clinical experience with ECT some my knowledge base is limited, so I have too acknowledge that.

There may indeed be abuses around this there is in alot of medical treatments, but there are bad apples everywhere.

My own dad died of cancer a few years ago, I was very involved in his treatment, however, I do not have a veto around it, and here we are talking about terminal cases which is different. As I work in a medical facility my family came to me, they did not have the skills to make the decision themselves, I not saying I did either, but I have a certain amount of knowledge and have medical professionals who are friend from who I could seek counsel from, there is a big different there.

I'm trying to interact with you questions the best I can with my limited knowledge, but maybe the health services forum would be better as there are a few psychs there.

From my viewpoint ECT is carried out in an ethical manner here, and as long as that continues I have no major issues with it. Sorry I tired now so I hope the above makes sense.

WalterMitty

one of the most vocal opponents of it died last week, Michael Corry.

sam34

firesidechat wrote: »

At present i believe all that is needed to overide a service users refusal
to therapy are recromendations from two psychiatrists.

its not quite as straightforward as that.

firstly, if someone is being given ECT against their consent, they will be an involuntary patient, detained against their will. to get to this stage, one of two things will have ahppened:

a) a family memeber will have made an application, a GP will have supportd it and a consultant psychiatrist will have signed them in

or

b) they will have been admitted voluntarily initially and the had their status changed, this is done by the treating consultant and another consultant who provides a second opinion

immediately once someone is detained in hospital, they get a solicitor appointed to them.this solicitor represents their interests at a tribunal. at this tribunal, there will be an independent consultant psychiatrist, a barrister and a lay person. the patient will have been asessed by ANOTHER independent psychiatrist, who provides a report for the tribunal.

so ALL these people need to agree that it is legally correct, and clinically necessary for the person to be detained, before anyone has spoken about ECT

then, for ECT to be administered, the treating consultant needs to seek a second opinion from another consultant

it is not a decision that is ever taken lightly.

with regards to your ppoint about cancer patients being given teh right to refuse treatment - that is not comparable to psychiatric treatment. cancer does not generally interfere with one's mental capacity to make a decision about one's own care, whereas serious mental illness can often do this.
cancer is not generally associated with a lack of insight, either.

why should family - generally who are not medically qualified- be given an over-riding say in treatment?

it is a fundamental prinicple of medical law that nobody can give or withold consent to any procedure on behalf of another adult. if that adult is incapable of making the decision for themselves, the decision then rests with medical professionals, and they are obliged to act in the patients best interests. of course it would be worth seeking a family's opinion, but i really dont think they should have the deciding vote.

irishh_bob

sam34 wrote: »

its not quite as straightforward as that.

firstly, if someone is being given ECT against their consent, they will be an involuntary patient, detained against their will. to get to this stage, one of two things will have ahppened:

a) a family memeber will have made an application, a GP will have supportd it and a consultant psychiatrist will have signed them in

or

b) they will have been admitted voluntarily initially and the had their status changed, this is done by the treating consultant and another consultant who provides a second opinion

immediately once someone is detained in hospital, they get a solicitor appointed to them.this solicitor represents their interests at a tribunal. at this tribunal, there will be an independent consultant psychiatrist, a barrister and a lay person. the patient will have been asessed by ANOTHER independent psychiatrist, who provides a report for the tribunal.

so ALL these people need to agree that it is legally correct, and clinically necessary for the person to be detained, before anyone has spoken about ECT

then, for ECT to be administered, the treating consultant needs to seek a second opinion from another consultant

it is not a decision that is ever taken lightly.

with regards to your ppoint about cancer patients being given teh right to refuse treatment - that is not comparable to psychiatric treatment. cancer does not generally interfere with one's mental capacity to make a decision about one's own care, whereas serious mental illness can often do this.
cancer is not generally associated with a lack of insight, either.

why should family - generally who are not medically qualified- be given an over-riding say in treatment?

it is a fundamental prinicple of medical law that nobody can give or withold consent to any procedure on behalf of another adult. if that adult is incapable of making the decision for themselves, the decision then rests with medical professionals, and they are obliged to act in the patients best interests. of course it would be worth seeking a family's opinion, but i really dont think they should have the deciding vote.

unfortunatley , due to the fact that pc wooly liberals call the shots in relation to mental health in this country , it is in reality almost impossible to have someone admitted against thier will unless they litterally kill someone 1st and at that point it enters the realm of criminality so mental health proffesionals have nothing to do with it

sam34

irishh_bob wrote: »

unfortunatley , due to the fact that pc wooly liberals call the shots in relation to mental health in this country , it is in reality almost impossible to have someone admitted against thier will unless they litterally kill someone 1st and at that point it enters the realm of criminality so mental health proffesionals have nothing to do with it

yet again, you spout inaccurate nonsense.

there have been over 4000 people detained against their will in this country in 2007 & 2008.

thats a lot of people, so it's inaccurate to say its "almost impossible".

there werent a corresponding number of murders or attempted murders perpetrated by these people, so its inaccurate to say that they "literally kill someone first".

when serious crimes are committed by seriously mentally ill people, the criminal justice system and the psychiatric system become interlinked...its why we have places like Dundrum and why we have legislation like teh criminal law insanity act.

you and your family's experience with one person, which you regularly cite as if it is the definitive word on mental health legislation, is just that - an example of ONE person.

i know you dont like to read the facts as i have posted them, but they are the facts.

you regularly call me all sorts of abusive names, and no doubt will continue to do so, - i dont particularly care, but the facts remain as they are.

firesidechat

sam34 wrote: »

its not quite as straightforward as that.

firstly, if someone is being given ECT against their consent, they will be an involuntary patient, detained against their will. to get to this stage, one of two things will have ahppened:

a) a family memeber will have made an application, a GP will have supportd it and a consultant psychiatrist will have signed them in

or

b) they will have been admitted voluntarily initially and the had their status changed, this is done by the treating consultant and another consultant who provides a second opinion

immediately once someone is detained in hospital, they get a solicitor appointed to them.this solicitor represents their interests at a tribunal. at this tribunal, there will be an independent consultant psychiatrist, a barrister and a lay person. the patient will have been asessed by ANOTHER independent psychiatrist, who provides a report for the tribunal.

so ALL these people need to agree that it is legally correct, and clinically necessary for the person to be detained, before anyone has spoken about ECT

then, for ECT to be administered, the treating consultant needs to seek a second opinion from another consultant

it is not a decision that is ever taken lightly.

with regards to your ppoint about cancer patients being given teh right to refuse treatment - that is not comparable to psychiatric treatment. cancer does not generally interfere with one's mental capacity to make a decision about one's own care, whereas serious mental illness can often do this.
cancer is not generally associated with a lack of insight, either.

why should family - generally who are not medically qualified- be given an over-riding say in treatment?

it is a fundamental prinicple of medical law that nobody can give or withold consent to any procedure on behalf of another adult. if that adult is incapable of making the decision for themselves, the decision then rests with medical professionals, and they are obliged to act in the patients best interests. of course it would be worth seeking a family's opinion, but i really dont think they should have the deciding vote.

I am aware of the procedures for involuntary admission.
Two consultants agree on ECT therapy to be administered to the service user. Fine, That is the current procedure. Where is the service user opinion coming into the equasion ? It's not. Should the service user not have the right to refuse or have someone represent him to relay his wishes to the consultants. What about his /her human rights.?
Why should this treatment be forced upon someone who wishes not to have the procedure. The service user must IMO have some say in this decision and ,it should be taken with the greatest of sincerity and respect.

sam34

firesidechat wrote: »

Where is the service user opinion coming into the equasion ? It's not. Should the service user not have the right to refuse or have someone represent him to relay his wishes to the consultants. What about his /her human rights.?
Why should this treatment be forced upon someone who wishes not to have the procedure. The service user must IMO have some say in this decision and ,it should be taken with the greatest of sincerity and respect.

their opinion and consent is sought - and they have refused.

the issue then is their capacity to refuse - the very nature of severe mental illness is that very often people simply do not have the capacity to make decisions surrounding treatment.

its not as if the consultant doesnt communicate with the patient, they do. tehy also communicate with families, but there is no valid reason why a family memeber should have the authority to make a treatment decision of the patients behalf.

what about their human rights? the mental health act enshrines their human rights. the tribunals and second opinions are in process to ensure their human rights.

is it ethical, humane or dignified to allow a human being suffer horrendously and die because of an illness that interferes with their ability to consent to treatment?

your little dig about how it should be taken with the greatest sincerity and respect - it is. it is not a decision taken lightly.
consultants dont waltz into the ward and say "im in the mood for giving ECT today, anyone here who could do with it?" . it is a decision which is given exceptional thought and consideration, and to suggest otherwise is, frankly, offensive.

firesidechat

sam34 wrote: »

their opinion and consent is sought - and they have refused.

the issue then is their capacity to refuse - the very nature of severe mental illness is that very often people simply do not have the capacity to make decisions surrounding treatment.

its not as if the consultant doesnt communicate with the patient, they do. tehy also communicate with families, but there is no valid reason why a family memeber should have the authority to make a treatment decision of the patients behalf.

what about their human rights? the mental health act enshrines their human rights. the tribunals and second opinions are in process to ensure their human rights.

is it ethical, humane or dignified to allow a human being suffer horrendously and die because of an illness that interferes with their ability to consent to treatment?

your little dig about how it should be taken with the greatest sincerity and respect - it is. it is not a decision taken lightly.
consultants dont waltz into the ward and say "im in the mood for giving ECT today, anyone here who could do with it?" . it is a decision which is given exceptional thought and consideration, and to suggest otherwise is, frankly, offensive.

That was by no means a dig, If i was digging you would know.
And yes i still stand by my statement,
ECT in my opinion is not a life saving therapy so where do you get the suffering horrendously and then die thought from.??
I meant no offense in any of my posts, so you should not feel offended.
If you do ,well that is not my fault.
Can we get back to the subject on hand .
I'm not saying consultants are wrong in their decisions, I am questioning if they should have the final decision..Thats all.

firesidechat

sam34 wrote: »

what about their human rights? the mental health act enshrines their human rights. the tribunals and second opinions are in process to ensure their human rights.

Some people feel their human rights could be respected more .
That is why they are lobbying for change in the Mental Health Act.
There are a few cases in front of the european court dealing with this issue from a few different states in the union.The court has ruled in favor of the service user right to refuse in a few cases.
So ,It is not an open and closed case.

JuliusCaesar

firesidechat wrote: »

ECT in my opinion is not a life saving therapy so where do you get the suffering horrendously and then die thought from.??

ECT is usually given in cases of severe depression which does not respond to any other treatment. The fatality risk is suicide.

irishh_bob

sam34 wrote: »

yet again, you spout inaccurate nonsense.

there have been over 4000 people detained against their will in this country in 2007 & 2008.

thats a lot of people, so it's inaccurate to say its "almost impossible".

there werent a corresponding number of murders or attempted murders perpetrated by these people, so its inaccurate to say that they "literally kill someone first".

when serious crimes are committed by seriously mentally ill people, the criminal justice system and the psychiatric system become interlinked...its why we have places like Dundrum and why we have legislation like teh criminal law insanity act.

you and your family's experience with one person, which you regularly cite as if it is the definitive word on mental health legislation, is just that - an example of ONE person.

i know you dont like to read the facts as i have posted them, but they are the facts.

you regularly call me all sorts of abusive names, and no doubt will continue to do so, - i dont particularly care, but the facts remain as they are.

three doctors and two social workers have told me personally that its almost impossible to be committed against your will in this country unless your commit a serious violent crime against another person , i can provode names of theese doctors and social workers to anyone who wishes to know

Gillo

irishh_bob wrote: »

three doctors and two social workers have told me personally that its almost impossible to be committed against your will in this country unless your commit a serious violent crime against another person , i can provode names of theese doctors and social workers to anyone who wishes to know

From experience as a patient, I saw a small number of people committed against their will, none that I was aware of committed any serious crime but definetly appeared to be a serious risk to themselves and possibley others.

firesidechat

I have add a poll to this thread.
I do have a vested intrest in this case and would appreciate your imput.

sam34

firesidechat wrote: »

That was by no means a dig, If i was digging you would know.
And yes i still stand by my statement,
ECT in my opinion is not a life saving therapy so where do you get the suffering horrendously and then die thought from.??
I meant no offense in any of my posts, so you should not feel offended.
If you do ,well that is not my fault.
Can we get back to the subject on hand .
I'm not saying consultants are wrong in their decisions, I am questioning if they should have the final decision..Thats all.

i get it from the fact that people with depression kill themselves

i get it from the fact that people with severe depression may stop eating and drinking, get electrolyte abnormalities and die

i get it from the fact that people with severe depression may stay in bed so long that they get muscle contractures, muscle breakdown and subsequent renal damage

that, to me, is horrendous suffering and death

sam34

irishh_bob wrote: »

three doctors and two social workers have told me personally that its almost impossible to be committed against your will in this country unless your commit a serious violent crime against another person , i can provode names of theese doctors and social workers to anyone who wishes to know

hearsay. interesting that you now claim it was told to you - you used claim it was your aunt. either way, its hearsay, and its inaccurate.

the facts show there were almost 4000 people committed over a two year period.

thats a fact. not hearsay. not "x told y who told z"

you may not like that, cause it doesnt support your view of the legislation, but its still a fact.

irishh_bob

sam34 wrote: »

hearsay. interesting that you now claim it was told to you - you used claim it was your aunt. either way, its hearsay, and its inaccurate.

the facts show there were almost 4000 people committed over a two year period.

thats a fact. not hearsay. not "x told y who told z"

you may not like that, cause it doesnt support your view of the legislation, but its still a fact.

and how long were those people committed for , 5 years , 5 months , 5 days , 5 mins ??????

sam34

irishh_bob wrote: »

and how long were those people committed for , 5 years , 5 months , 5 days , 5 mins ??????

totally varies.

taken on a case by case basis, based on clinical need

irishh_bob

sam34 wrote: »

totally varies.

taken on a case by case basis, based on clinical need

one doctors definition of clinical can vary from another doctors opinion on the same patient

the policy towards those who are not the full schilling is in my view something similar to the states policy regarding that girl who died and who,s story is in the news right now , one of permananent thumb twiddling

bluecatmorgana

IMO I think it should be two consultants and the service user consent. Even if the service user cant make a decision properly it should not be taken out of their hands. How can you for definite tell if someone cant make informed decisions anyway? I work with adults with learning disabilities with the mental age of 2/3 years old, I would hate to think of someone making that decision on their behalf.

ECT is a risk, regardless of how calculated it is and I dont think anyone else professional or otherwise should agree to that risk for someone else.

A lot is still unknown about ECT, for something to be around for fifty years and still be so ambigous does not sit well with me, regardless of how much it could "help" me.

sam34

bluecatmorgana wrote: »

Even if the service user cant make a decision properly it should not be taken out of their hands. How can you for definite tell if someone cant make informed decisions anyway?

its pretty easy for trained professionals to do so. and its something thats done for a variety of reasons regularly by doctors - asked to assess capacity to make decisions about treatment for physical illnesses, not just mental illness, and there are often opinions sought on capacity to make legal decioions such as making a will, registering an enduring Power of Attorney, needing to be a ward of court etc

firesidechat

[QUOTE=sam

the facts show there were almost 4000 people committed over a two year period.
[/QUOTE]

SAM.
Would you have a link to that info.
I am not doubting you, just interested in reading it.

sam34

i got it from the mental health commission website

i'll have a look for the link later and post it up

sam34

http://www.mhcirl.ie/News_Events/MHC_Annual_Report_2008.pdf

scroll down to pgs 40 to 43, they give details on numbers of involuntary admissions for 2008 (sorry, i dont know how to link to those specific pages)

the 2007 report gives similar figures

Molecule

bluecatmorgana wrote: »

A lot is still unknown about ECT, for something to be around for fifty years and still be so ambigous does not sit well with me, regardless of how much it could "help" me.

You could also argue that it's been around for fifty years and no long-term side effects of modified ECT have been found, which makes it safer than most medications (modified ECT is ECT given under general anaesthetic and with muscle relaxants, which is how it is administered in Ireland and most other countries).


In terms of consent, I work in the area and would say that in an ideal world of course service user/patient/client consent should be sought but on the occasions where an individual is obviously incapable of consent then it should be up to two qualified consultants to make the call. I disagree with giving family members a definitive say in their relative's treatment in this case as often they do not understand the treatment, how it works and what a difference it can make. Often all they have heard is the (IMO) irresponsible horror stories put about by certain elements of the media. It sometimes happens that a patient will consent and will ask for their families not to be told as they do not think that their families would understand but they (the service user) feel that the treatment would be beneficial to them.