Electro-convulsive Therapy on Australian Children Banned

Rob Wipond
14
136

After “fierce debate”, the government of the province of Western Australia has voted to completely ban all use of electro-convulsive therapy (ECT), or electroshock, on children under the age of 14, reported ABC News.

“The law imposes a $15,000 fine on anyone performing the therapy on a child under 14,” reported ABC News. “A child aged between 14 and 18 who is a voluntary patient cannot have the treatment without informed consent and approval by the Mental Health Tribunal.”

The president of the Western Australia Association for Mental Health told ABC News that the bill was long overdue. “To date there have been no safe guards, and that’s been highly problematic, at least now we have some.”

Electroshock therapy on under-14s banned in WA after law passes Parliament (ABC News, October 17, 2014)

14 COMMENTS

  1. Below is ISEPP’s letter by Dr. Toby Watson (www.psychintegrity.org) to the Health Ministry of Australia, helping inform them of the dangers of ECT. With ISEPP’s help, this ban has taken effect ! Way to go ISEPP ! Don’t just read about mental health issues, join ISEPP today and help teach the world:

    —– Original Message —–
    From: Toby Watson PsyD – Office
    To: [email protected] ; [email protected]
    Sent: Tuesday, November 05, 2013 11:27 AM
    Subject: ECT and Psychosurgery Legislation- Research Says No Safety and Long Term Benefit

    Dear Honorable Ministers Morton and Hames,

    I recently learned from a researcher friend in Australia, Dr. Brian Kean, PhD, that there is a new mental health act being proposed that would allow minors to engage in electro-convulsive shocking (ECT) and psychosurgery without parental consent. I have special expertise and interest in the area of ECT, as I have given testimony to the United State Federal Drug Administration (FDA) on this specific topic, whereby, the FDA has upheld the supported request to keep the stringent classification upon these devices. As Clinical Director of an outpatient mental health center here in the United States, as the Past Chief Supervising Psychologist for the State of Wisconsin-USA, Department of Corrections-KMCI, and as the past Executive Director for the International Society for Ethical Psychology and Psychiatry, have been able to witness first hand the long term after-effects of ECT. I ask that you please read the summary of peer reviewed research on the safety and effectiveness of ECT, because you deserve to have all the information.

    In 1979, the FDA categorized the ECT device as a Class III, high risk device, meaning that it’s benefits have not been shown to outweigh its risks, and that it presents a “potential unreasonable risk of injury or illness.” It ruled that brain damage and memory loss were risks of the procedure. Thirty plus years later and most recently within the past few years, the FDA upheld it’s decision to keep the Class III listing, as no evidence has accumulated to disprove these findings. Rather, there has been a stream of continued evidence in the research demonstrating significant harmful effects.

    There are seventy years of reports of permanent extensive amnesia and memory dysfunction in a large percentage or majority of patients. [i] Reviewing the evidence to date, in 1985 the NIMH Consensus Conference on ECT found that the average loss was eight months of life and that the majority of ECT patients had chronic memory impairment three years after “treatment”. [ii] Then in 2003, the first-ever systematic review of all the evidence to that date found at least 33% of ECT patients experienced permanent memory loss. [iii] An even more recent prospective study found that at least 45% of patients experienced permanent amnesia, and 40% reported loss of intelligence. [iv]

    The research on permanent amnesia can be summarized as follows: researchers have mostly avoided conducting any long term, six months or longer studies, but whenever they have looked for permanent memory deficits, they have found them. There have been only two long term (e.g. six month) studies of amnesia done in the past 33 years, and both, despite serious methodological problems, show that permanent extensive amnesia is common. [v] One found “provocative evidence for autobiographical memory loss lasting at least six months” and the other, the largest study of memory ever done, concluded “adverse effects can persist for an extended period, and (usage) characterizes routine use of ECT in community settings.”

    In seven decades there here have been only two methodologically sound randomized controlled clinical trials investigating whether ECT is more effective than drugs, and neither of these studies compared shock to drugs currently in use today. [vi] Interestingly, it has never been compared to other forms of true treatment, such as psychotherapy.

    In 1992 and again in 2006 researchers systematically reviewed the literature on real vs. sham ECT (pretending they gave someone ECT when in fact they did not), and concluded the studies show no advantage for real ECT. [vii] Even the most recent American Psychiatric Association Task Force report, though it asserts ECT’s efficacy, did not cite a single study showing real ECT having a superior outcome to a sham ECT, when treating depression.

    In 1985, the NIMH found there was no evidence for any benefit of ECT lasting more than four weeks, and there are no studies since 1985 showing any longer benefit other than Huuhka, Viikki, Tammentie’s study published in the Journal of ECT in April 2012. Huuhka et al acknowledged the relapse rate of short term c/mECT for depressed patients is 40-60% even with anti-depressant medication continuing, and for patients with more severe pathology (e.g. schizophrenia, bipolar), patients were even more likely to relapse within 8-12 months.

    Another large recent study indicated approximately one half of patients had no significant improvement to ECT, even in the very short term, and the majority who relapsed within one and six months later were suffering long term adverse effects, while overall only 10% were in remission. [viii] And another more recent study found claims of 70-90% efficacy to be wildly inflated, with the actual rates from 30 to 46%; however, these positive outcomes were measured only in the few days immediately after ECT. [ix]

    Despite claims repeatedly made that ECT is safe and effective for severe depression and helps with suicide, research shows that ECT has no protective effect against suicide either in the short or long term. [x]

    In one of the very few studies ever performed, researchers in 1985 found that ECT patients committed suicide more frequently than those who had not received ECT, even when level of depression was taken into account. [xi]

    Finally, in the January 2007 journal Neuropsychopharamacology researchers highlighted in a large scale study how current ECT techniques used still produce cognitive effects immediately and after six months post ECT. [xii] They state ECT produces “pronounced slowing of reaction time” and significant “persisting retrograde amnesia”. Dr. Harold Sackheim, the chief researcher had been a strong ECT advocate.

    Recall, prior to modern brain imaging technology, dozens of human and animal autopsy studies documented brain damage from ECT. In the modern era, brain scan studies of psychiatric patients show a correlation between treatment with ECT and cerebral atrophy. The very few studies which set out to investigate the question of ECT’s effects on brain structure are both seriously methodologically flawed and inconclusive (i.e. they did not use normal controls, and allowed patients who had previously had shock to be considered as “before shock” or non shock subjects.)

    Therefore, in summary researchers John Read and Richard Bentall in 2010 set out to conduct a large literature review and meta-analysis review of over 100 studies on the efficacy of ECT when compared to sham-placebo ECT. [xiii] They concluded:

    Controlled studies show minimal support for effectiveness of ECT for depression or ‘schizophrenia’; however, ONLY
    a) during treatment,
    b) for some patients,
    c) on some measures,
    d) and only by psychiatrists, not other raters.
    • There was no evidence of any benefits beyond the short treatment period.
    • There are no placebo-controlled studies showing ECT prevents suicide.
    • There is persistent evidence of permanent brain dysfunction, primarily evidenced in the form of retrograde and anterograde amnesia, and evidence of significant increased risk of death by ECT.’

    They concluded by stating:

    “Given the strong evidence (summarized here) of persistent and for some, permanent brain dysfunction, primarily evidenced in the form of retrograde and anterograde amnesia, and the evidence of a slight but significant increased risk of death, the cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified.”

    Given the above, and that at least 55% of patients who had ECT would not recommend it nor want it do to them again [xiv], I think it is relevant to NOT support allowing minors to use ECT. This seems to be a growing consensus around the world, because in February 2013, the United Nations Special Report on Torture, Mr. Juan Mendez recommended an “absolute ban on forced and non-consensual medical interventions against persons with disabilities, including non-consensual administration of psychosurgery, electroshock and mind-alternating drugs such as neuroleptics, [and] the use of restraint and solitary confinement, for both long and short-term application.” http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf
    Children’s parents need to be fully informed of risks and of any decisions their child may make. The decision to use ECT always carries a life-long consequence, and most often the risk are under-reported by practitioners who are paid to use these machines. Children are unable to appreciate the extreme nature of such intervention, and given the developing nature of their brains, ECT should never be used on anyone under the age of 18. Given they will likely be already vulnerable due to their mental suffering and age, it is imperative they make mental health decisions with parental consent, and any biological intervention only after every possible other option has been fully exhausted to it’s fullest extent. Please say NO to the pending legislation because children need protection from my mental health industry.

    Regards,

    Dr. Toby Watson, Psy.D.
    ISEPP Past Executive Director, Current Board Member
    Associated Psychological Health Services-Clinical Director
    2808 Kohler Memorial Drive, Suite 1, Sheboygan, WI 53081
    920-457-9192 920-918-7377

    Dr. Brian Kean, PhD, ISEPP International Executive Director
    Dr. Charles Ruby, PhD, ISEPP Board Chairman

    • Toby,

      Thanks so much for this awesome summary of the evidence regarding ECT. It makes advocacy so much easier to have a comprehensive list of references to support an alternative viewpoint. That this even needs to be said is in itself disturbing, and of course, many in the field really don’t care about or don’t want to hear any actual data that contradicts their favored (and most profitable) worldview. But for those on the fence, this kind of info is critical. Thanks again!

      —- Steve

    • This is brill and might be just what I am looking for.

      I’m thinking of going to my local psyche hospital and putting crime scene tape around the door of the ECT suite and calling the press.

      This little post could form the basis of my press release, and if it comes to it, my defence in court

  2. I also spoke to them about this issue, and have posted their response to my letter below:

    Minister for Mental Health; Disability Services; Child Protection
    Ourref: 43-10519/83
    Toby Watson, [email protected]

    Dear Mr Watson

    Thank you for your recent correspondence to the Minister for Mental Health,
    regarding the Mental Health Bill 2013. The Bill was introduced into Parliament on 23
    October 2013 and represents a significant step forward for mental health reform in
    Western Australia.

    The Bill has been developed over a 10 year period and has involved extensive
    consultation from a range of stakeholders including people with a lived experience of
    mental illness, families, carers, clinicians and non-government organisations. During
    the consultation process on earlier drafts of the Bill, over 1,300 written submissions
    were received and 40 forums held across the state were attended by 600 people.
    This feedback, both written and verbal, has been vital and developing and shaping
    this important piece of legislation.

    The Bill makes significant improvements upon the Mental Health Act 1996, which is
    the current legislation in Western Australia. This includes strengthening the rights of
    people experiencing mental illness and providing for greater family and carer
    involvement with the treatment and care of their loved ones. It also provides new
    levels of rights protection, providing processes and safeguards around involuntary
    treatment to protect some of society’s most vulnerable people.

    I note that you have raised some specific concerns regarding the clauses which
    regulate the use of electroconvulsive therapy and psychosurgery on children and the
    involvement of parents. Please be assured that the Bill provides stringent
    safeguards in these areas, considerably greater than those in the current Act.

    Electroconvulsive therapy
    Electroconvulsive therapy, or ECT, is a form of medical treatment for severe
    depression, bipolar disorder and psychotic illnesses such as schizophrenia. It may
    be recommended by a psychiatrist when symptoms are severe or other forms of
    treatment, such as medication or counselling are ineffective.

    Under the current Act, ECT can be performed on an involuntary patient if it is
    recommended by the treating psychiatrist and approved by a second psychiatrist.
    The current Act does not differentiate between adults and children. As such, a child
    of any age could potentially receive ECT.
    1
    7th Floor Dumas House, 2 Havelock Street, West Perth Western Australia 6005
    Telephone: +61 8 6552 6900 Facsimile: +61 8 6552 6901 Email: [email protected]

    ECT is not a common treatment for children, in any case, the Biii bans the use of
    ECT on children under the age of 14. As an additional safeguard, the Mental Health
    Tribunal (Tribunal) is required to give approval before ECT can be provided to a
    child.

    Whether or not a child has the capacity to consent to receive ECT is a decision to be
    determined by the patient’s psychiatrist. The Bill creates a presumption that children
    do not have decision making capacity. However, this can be reversed where a child
    demonstrates that they do have capacity. This is the same position as for general
    health, where a child needs medical treatment.

    Where the child does not have capacity, the decision to provide informed consent for
    ECT lies with their parent or guardian. Conversely, a child with capacity may
    consent to ECT, which may not be reflective of their parent or guardian’s wishes.
    The Bill requires that any decision regarding a child must take into account the views
    of their parent or guardian, including a decision surrounding ECT. In determining
    whether or not to approve an application for a child to receive ECT, the Tribunal
    must consider the views of the child’s parent or guardian.

    Psychosurgery
    Under the current Mental Health Act 1996, psychosurgery may be performed with
    the informed consent of the patient in addition to the approval of the Mental Health
    Review Board.

    Psychosurgery has not been performed in Western Australia since the 1970’s.
    However, there is evidence of emerging forms of treatment which meet the definition
    of psychosurgery and require regulation. In particular, one treatment being
    undertaken in other jurisdictions is Deep Brain Stimulation. There is mounting
    evidence that this treatment is beneficial in treating illnesses such as depression and
    obsessive compulsive disorder. It is considered to be inappropriate for Government
    to deny a person access to a treatment which may greatly assist them, provided
    appropriate safeguards are in place.

    The position in the Bill is similar to the current Act, with extra safeguards.
    Psychosurgery can only be provided with the informed consent of the patient in
    addition to the approval of a specially constituted Tribunal.

    There are other additional safeguards in relation to children. The current Act does
    not differentiate between children and adults, meaning that psychosurgery could
    potentially be performed on a child of any age. Based on clinical advice, the Bill
    prohibits psychosurgery on a child under 16 years. In deciding whether or not to
    approve psychosurgery, the Tribunal must have regard to the views of the child’s
    parent or guardian, amongst other matters.
    2
    Other provisions for the protection of children
    The current Act does not make reference to children at all. There are numerous
    provisions in the Bill which protect children, for example:
    • Requiring the child’s personal support person/s (anticipated to be the child’s
    parent or guardian) to be:
    o notified about an incident of detention, admission, discharge, and
    similar matters;
    o informed about treatment and care; and
    o involved in treatment decisions and treatment, support and discharge
    planning.
    • The views of the child’s parent or guardian to be considered at all times.
    • The wishes of the child to be considered at all times.
    • The best interests of the child to be a primary consideration (taking into
    account the safety of other people, which cannot be ignored).
    • Requiring an advocate from the Mental Health Advocacy Service to contact a
    child within 24 hours of involuntary admission.
    • Requiring the Tribunal to review a child’s involuntary status within 10 days of
    admission.

    I hope that the above in formation some use. If you require any further information
    on the Bill, I encourage you to visit the Mental Health Commission’s website
    http://www.mentalhealth.wa.gov.au/

    Yours sincerely
    Dawn FitzGerald
    Chief of Staff to the
    MINISTER FOR MENTAL HEALTH
    21 NOV 2013
    3

    • TEN years? And still to ignorant and blind to draft legislation banning this torture for ANYONE at any time?? A “fierce” debate?? Why? People are that stupid and uninformed? The lobby is so strong in favor of ECT?

      I notice this letter from Dawn does not address the issues raised by Dr. Watson. He has laid it out clearly : dangerous, unpredictable, causes brain damage, no safety, no efficacy. But she is babbling away about protections and safeguards?? There is a giant elephant here, Dawn. This procedure is useless, has no scientific validity as Bental and Read pointed out. It ruins people’s lives.
      The “best interests” of everyone, child or adult include not being brain damaged by a bogus “treatment”.

      Is the government and health ministry full of completely stupid, ignorant, uninformed, indifferent, and uneducated individuals??

      Wait!! Maybe they got a letter from Dr. Healy pointing out how great ECT is…

      • I’m absolutely offended. I have a letter here from Minister Morton herself telling me she can not answer questions that relate to specific sections of the Act.

        Long story but I don’t think she wanted to discuss the fact that nobody has a right to consent to treatment in Western Australia, or that the Chief Psychiatrist has reworded the section I asked about to remove any accountability for AMHPs.

        So I explained that it wouldn’t matter what protections are afforded in the new Act until someone is appointed to actually enforce them.

        Still, I guess she can’t deny that she didn’t know now.

          • Chrisreed
            yes, psychiatrists are an absolute law unto themselves here – no-one dares question their opinion, and if they do they are comprehensively labelled and/or dismissed as being on the lunatic fringe.

            Earlier this month we had “Mental Health Week” and it was so full of propaganda about drugs and ECT that it probably set patients’ rights back 100 years and increased any stigma it was supposed to address….there was nothing at all on possible side effects, on the efficacy of treatments or on the influence of big pharma.

            There was even a “reality” show on for three nights where cameras were allowed into the locked ward of one of our biggest hospitals….again it was forced meds, forced meds, more forced meds, and grateful happy patients who were obviously regulars. They even had a satisfied ECT patient who was so clearly brain damaged it was scary.

            Boan is certainly not exaggerating when he outlines the sort of thing he is coming up against!

          • It certainly is chrisreed.

            I’ve made the comment before but it’s like they have put the Grand Wizard of the Ku Klux Klan in charge of Equal Opportunities, and one can imagine what the outcomes would be in that situation.

            That show “Changing Minds” was interesting Kim. Listening to patients repeating the myth of the chemical imbalance, and the psychiatrist speaking about “it’s like insulin for diabetes” line. ECT the new wonder treatment etc.

            The opportunity was there for some critique of our system and the producers missed it, or were they too afraid to tackle the issues. I suspect the latter.

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