Part II in a series of installments investigating the plight of a man subjected to over 50 shock treatments against his will (and the efforts to put a stop to it). For Part I, see The Curious Case of Over 50 Consecutive ECTs in Melbourne. For more information about this case, watch the nine-minute news segment.
When GD’s father asked me to get involved in this case, my first step was to approach the state of Victoria’s Department of Health and Human Services. I was consistently directed to the Office of the Chief Psychiatrist as the only person who could respond to my concerns. Nobody else seemed permitted to engage at all. However, one senior DHHS official took my concerns seriously enough to approach the Chief Psychiatrist personally and ask him to meet with me.
Now, my faith in the ability of psychiatrists to investigate and control their own is not very high in general, and is especially low in relation to ECT (albeit based on an n of 2 study).
As a very junior Clinical Psychologist in Derbyshire, England, in the 1980s, a patient whose notes read “heart condition – ECT contraindicated” had been given ECT anyway. He died within an hour. My trying to discuss this at our team meeting the next day resulted in my being physically removed from the room. The page with the file note about the man’s heart condition was removed from his file. For over a year I tried to find an authority that would investigate. I failed.
More recently, during my time in New Zealand, I again had cause (a far less serious cause) to lodge a complaint against a psychiatrist. In an attempt to counter a service user-led public campaign to ban ECT, this psychiatrist had written in the NZ Herald the usual claims about memory loss being the depression not the electric shocks, but she’d added that she was currently running a very large ECT trial and that 80% of people were getting better. I wrote to her enquiring whether she was using a placebo group (a very basic requirement of efficacy research) and asking to see her data (an accepted process once a researcher has gone public with their findings). She was “professionally and personally insulted” by my letter, and refused to correct what I believed to be misleading public statements.
I wrote to the Royal Australian and New Zealand College of Psychiatrists informing them of my concerns, stressing that they were relatively minor but asking for their code of ethics and their complaints procedure. There followed more than a year of ignored emails and phone calls repeatedly asking to see their code and procedure and asking how, or whether, they were addressing my concerns. Eventually I received an embarrassed phone call from their CEO (on his last day with the organisation) apologising profusely, and explaining that the College could not send me their code of ethics or their complaints procedure because neither existed.
I did eventually get a letter saying that the NZ branch had looked into my concern (without asking me to attend a hearing, or even telling me about a hearing – if indeed one ever took place) and determined that there was no case to answer. I gave up. (The study in question was never published.)
- promotes the rights of people receiving mental health treatment in public mental health services
- is responsible for monitoring restrictive practices, electroconvulsive therapy and reportable deaths.
The Chief Psychiatrist is currently Dr Neil Coventry, head of Child and Adolescent Mental Health Services at the private healthcare company Austin Health, whose website states:
“We believe in consumer-centred care delivered with respect and integrity” and “We facilitate supported decision making with our consumers and acknowledge and respect a person’s capacity to make informed decisions.”
The email I received, however, came from the Deputy Chief Psychiatrist, Aged Persons, who is Emeritus Professor O’Connor, Head of the Aged Mental Health Research Unit based at Monash University. The Professor is an advocate of ECT, especially for older people. His University website page states: “Major topics of interest at present concern ECT as a treatment of severe late-life depression” and cites: O’Connor, D.W., 2008, Electroconvulsive therapy, in Oxford Textbook of Old Age Psychiatry, eds R Jacoby et al. Oxford University Press, UK, pp. 201-214.
Dr O’Connor wrote (28, January, 2016):
Dear Dr Read,
I understand that you have sought to meet with this office concerning the use of electroconvulsive treatment (ECT) in the case of a mental health client. You will understand that we are not at liberty to discuss individual people.
ECT is endorsed by the Office of the Chief Psychiatrist as an effective, evidence-based treatment modality. We have recently updated our clinical guidelines which can be found on our website. We take the application of ECT very seriously indeed.
With kind regards,
Deputy Chief Psychiatrist, Aged Persons (Mon, Tue, Thu)
Department of Health and Human Services | 50 Lonsdale Street, Melbourne, Victoria, 3000
T: 61+3 9096 7571| F: 61+3 9096 7697 I E: Daniel.O’[email protected]
I read the ‘recently updated’ (December, 2015) guidelines carefully.
It is one of the most pro-ECT sets of guidelines I have seen in my 40 years of involvement with these issues. It claims, for example (with no research in support), that ECT should be used “as a treatment of choice” “rather than as a treatment of last resort” as is the case almost everywhere else in the world; and even that “ECT is sometimes the safest treatment of serious mental disorder during pregnancy” (again with no research to support this particularly idiosyncratic opinion).
I replied (29, January, 2016):
Dear Dr O’Connor
Thank you for your swift response.
I think there may have been a misunderstanding.
I do not wish to discuss an individual patient.
I wish to discuss the conduct of the psychiatrists at Upton House, Dr Katz in particular, who have been responsible for the administering of over 50 ECTs consecutively to a patient, and have reportedly repeatedly restrained this patient to a bed, on one occasion for approximately 60 consecutive days.
I request that you intervene to stop this unprecedented and potentially very damaging excessive use of ECT.
I wish to lodge a formal complaint against this unprecedented excessive use of ECT, which has absolutely no research evidence base to support it, and request an independent investigation. Are you authorised to receive such a complaint and investigate it?
I assume so, since your website states that one of the four primary purposes of your Office is to ‘promote the rights of persons receiving mental health treatment from public mental health services’.
If not, please advise me as to who in the DHSS is the appropriate body to complain to. Thanks.
Thanks for referring me to your guidelines on ECT (which I note have been updated just last month, since the case in question came to public attention). I find it a rather problematic and biased document in that it barely mentions the cognitive impairments so often caused by ECT. It is of grave concern that an Office representing the State of Victoria should issue guidelines without citing a single research study in support of any of the statements in the document. Some of the claims are contentious in the extreme. For example In keeping with international guidelines, the document accurately defines a ‘Course of ECT’ as ‘A single course of ECT limited to a maximum of 12 treatments performed over a period that cannot exceed six months (p 8), but then goes on to contradict this by claiming that ‘One course may immediately follow another’ (p. 13). This is not at all consistent with international guidelines, and there is no research to support this somewhat bizarre suggestion. A suspicious person might wonder whether the timing and some of the content of these updated guidelines are an attempt to justify the conduct of the Upton House psychiatrists.
You state, in your email and in your guidelines, that ECT is an effective, evidence-based treatment. Please send me references to any study that shows that ECT has better outcomes than simulated ECT beyond the end of the treatment period. I attach my peer-reviewed review showing that there never has been such a study.
And, if you find the administration of over 50 consecutive ECTS by Dr Katz and his colleagues acceptable, please send me the research showing that anyone who has not improved after 10, 20 or 30 is likely to improve with further treatment.
Finally are you aware of the research (attached) showing that the number of ECTs is the best predictor of long term cognitive impairment in the form of anterograde amnesia? The earlier somebody intervenes to put a stop to Dr Katz and his colleagues in this case, the smaller the chance of permanent brain damage.
I hope that you will take this issue seriously as it is has the potential to seriously undermine the confidence of the public in our public mental health services and the profession of psychiatry in particular.
I look forward to hearing from you and arranging a time for me to meet the Chief Psychiatrist now that the misunderstanding has been cleared up.
Professor John Read
At the time of writing this, four weeks later, I have had no reply whatsoever to this formal complaint and direct appeal for immediate action. Not even an acknowledgement.
What chance would a service user, or family member, or a whistle-blowing nurse, have of getting a genuine response from this Office, I wonder?
Yet this is the Office to which the Department of Health and Human Services refers all mental health concerns, and which the Minister of Mental Health has charged with investigating Drs Katz, Segal and Mackay at Upton House and their Managers at Eastern Heath.
The next installment will cover the actions of the Mental Health Tribunal.