This is the final of four installments about the bizarre, ongoing conduct of psychiatrists at Upton House, an Eastern Health psychiatric facility in Melbourne, and the collusion with their conduct by all relevant agencies. See previous installments (Part I, Part II and Part III) or this 9 minute TV News clip for the story thus far.
This last installment will document the failure, so far, of the State and Federal Governments to intervene in even this most extreme and blatant example of abuse of power by psychiatry.
But first a brief, depressing update. Dr Katz and his subordinate psychiatrists responded negatively to the Mental Health Tribunal’s decision (February 18th) to refuse them the right to continue the series of over 50 ECTs to GD – they responded by cancelling GD’s leave, reverting to tying him to his bed, and appealing the MHT decision. The MHT convened on March 2nd and, to everyone’s amazement, granted Drs Katz, Mackay and company permission to give GD yet another 12 ECTs (which they started that same afternoon and the next day).
The MHT’s rationale? GD had refused psychiatric drugs and so there was no longer a “less restrictive” treatment option. So apparently he has capacity to refuse drugs, but does not have the capacity to refuse the ECT and so can be given ECT against his will. Note also that these Eastern Health psychiatrists do not appear to recognise psychotherapy, CBT, peer-support groups, or any other non-biological approach as treatment options.
How incredibly sad to spend one’s days trying to ameliorate human distress and disorientation armed only with electricity and chemicals.
How sad that we allow such people responsibility for, and power over, our loved ones when they most need people to listen to their feelings and respect their needs.
How sad that none of the following agencies of the State of Victoria (see previous installments) seem willing, to date, to do anything whatsoever to intervene in a situation so grotesquely and blatantly abusive, and that none of them seem at all interested in what the research says is the most likely outcome of the psychiatrists’ conduct:
The Department of Health and Human Services
The Office of the Chief Psychiatrist
The Mental Health Tribunal
The Mental Health Complaints Commissioner
Given the very high publicity of this case we can add the Royal Australian and New Zealand College of Psychiatrists to the list of organisations who know exactly what Dr Katz and his colleagues are doing but have not stepped in to stop it. And what about the individual senior psychiatrists, across the State and the nation, who one might imagine would care about the reputation of their profession? Not one has spoken out on the issue. Perhaps they have been trying privately to persuade the Upton House psychiatrists to abide by some semblance of professionalism and evidence-based practice? If so, Dr Katz seems happy to ignore them and have his underlings do the same. And no, “I was just following orders” is not an acceptable defence in such circumstances. Do all the anaesthetists and nurses involved have no grasp of professional ethics, or interest in evidence-based medicine, either?
I suppose all my writings, and that of so many others, on this and related issues will be dismissed by the defendants as ‘anti-psychiatry.’ That is, after all, what rigidly biological and authoritarian psychiatrists do best: come up with a label to characterise something that scares them or they can’t understand, and then convince themselves that they have found its cause. “Why does Ms X hear voices?” “Because she is a schizophrenic and schizophrenia makes people hear voices.” “Why does Mr Y believe that ECT causes brain damage, especially when given week after week after week?” “Because he has anti-psychiatry disorder and that makes people think that electricity is bad for the brain.”
Meanwhile our hopes for change, at least here in Australia (but I suspect elsewhere too), clearly lie outside psychiatry and the systems that psychiatry has helped establish to create the illusion of safeguarding our rights. We must try, therefore, to influence our elected governments. I will end, then, with my thus far unsuccessful attempts ‘down under.’ If you haven’t had enough of my correspondence with officialdom (I know I have) please read my three letters, below, to our Minister of Mental Health, Martin Foley (about whom I have heard very good things, especially on housing issues):
If you want to join in, his email is: [email protected]
Maybe cc to the State Premier at: [email protected]
OPEN LETTER TO MINISTER OF MENTAL HEALTH (Victoria), THE HON. MARTIN FOLEY, M.P., RE THE CONDUCT OF UPTON HOUSE PSYCHIATRISTS
4th February, 2016
The Mental Health Act (2014) was introduced in order to reduce involuntary treatment and restraint and to enhance the human and legal rights of Victorians when we use mental health services, including the right to the least restrictive treatment possible.
Upton House psychiatrists, under the oversight of Dr Paul Katz, have administered over 50 ECTs consecutively to a Mr GD, and are continuing to administer even more. This is against an ‘advance order’ written when well by GD, and despite the pleas, over many weeks, of his father, mother and brother, and despite the ongoing pleas of GD himself.
There is no precedent internationally for this. The average number of ECTs in a series, based on a review of 70 international studies, is eight (Leiknes et al., 2012).
There is no research evidence that administering more than 10 is effective. There is robust evidence that the best predictor of the long-term/permanent brain damage (memory loss) often caused by ECT is the number of individual ECTs given (e.g. Sackeim et al., 2007 – attached).
The small but significant risk of death – typically cardiovascular failure (e.g. Shiwach et al. , 2001) also increases with each individual shock, partly because the seizure threshold increases over even a normal series of 6 to 10 ECTS, such that the dose of electricity needed to produce the seizure increases. (The hospital records I have seen show that on one occasion already GD was given four shocks in one day in an attempt to induce the necessary convulsion).
Drs Paul Katz and Sarah Mackay are aware of this research via my submission to the Mental Health Tribunal.
GD has been tied to his bed on many occasions, reportedly for over 60 days on one occasion. Dr Katz does not deny this but believes it is acceptable because GD is tied up with velcro “not chains” (17.12.2015). http://www.abc.net.au/7.30/content/2015/s4374913.htm
I am informed that the psychiatrists involved appear to be denying GD’s human/legal rights by preventing him from attending his own MH Tribunal (12.1.2016), and reportedly preventing him (by restraint) on several occasions from being seen by a psychiatrist wanting to provide a ‘second opinion’.
The Upton House psychiatrists maintain GD is not competent to refuse ECT, but this is contradicted by a private psychiatrist.
The Mental Health Tribunal hearing (12.1.2016) I attended (at the father’s request) was grossly biased on numerous counts. (For documentation of the full extent of the bias see my formal complaint to the Tribunal calling for the suspension of the Tribunal Chair and of the supposedly neutral psychiatrist on the panel, and for an independent inquiry – attached).
My raising these issues formally with the Office of the Chief Psychiatrist led to a dismissive response (attached) asserting that ECT is safe and effective and referring me to their recently update guidelines. These guidelines are bizarre in that they do not refer to a single research study but are just a collection of personal opinions. These opinions include the recently added claim that multiple series of ECTs can be given consecutively. This suggests that in the state of Victoria, but nowhere else in the world, psychiatrists can give an infinite number of ECTs consecutively. The timing of this extraordinary change is highly suspicious to any neutral observer. The Office has failed to respond to my request (attached) for the research base supporting their various claims about ECT. There is none.
Responding to the media in relation to GD’s case, Eastern Health’s executive director Mr Matt Sharp reportedly said (28.1.2016), ironically in the circumstances: “We value the input of patients and families to ensure we act in their best interests.” Perhaps unaware of the fact that his employees have been reported to be actively preventing it, Mr Sharp said the father “had been given the opportunity to obtain a second medical opinion for his son. To our knowledge, a second opinion has not yet been obtained”.
In conclusion, there seems to be little or no protection of the human or legal rights of people using mental health services in the State of Victoria. Some psychiatrists here seem able to conduct themselves in what most experts in the field would consider a potentially dangerous and unethical manner with no regard whatsoever for whether their actions have an evidence-base or are safe, while knowing that Eastern Health management and their colleagues on the Mental Health Tribunal and at the Office of the Chief Psychiatrist will do nothing to intervene however unprofessional their behavior.
If I, as a Professor of Clinical Psychology with 40 years clinical and research experience in this field, can be so easily dismissed/ignored by the relevant systems in Victoria, what chance do the average users of mental health services and their families have of being heard in this State?
I have spoken today with the Mental Health Complaints Commissioner and have just lodged a formal complaint with them about the psychiatrists involved, Eastern Health management, the Mental Health Tribunal and the Office of the Chief Psychiatrist.
I am making this letter to you public in the hope that this may facilitate:
(1) a rapid intervention to end the brutal and potentially dangerous treatment of GD
(2) (less urgently, but vital to prevent this sort of abuse of power happening again) a full and genuinely independent investigation into the conduct of Dr Katz and other staff and mangers at Upton House/Eastern Health, and into the complicity of senior members of the Mental Health Tribunal, and the Office of the Chief Psychiatrist, in knowingly allowing Dr Katz and his staff to continue to abuse their positions of trust and authority for such an extended period of time.
Professor John Read
COVENTRY, N. (2015). Electroconvulsive treatment: Chief Psychiatrist’s guideline. State of Victoria, Department of Health and Human Services. December. http://health.vic.gov.au/chiefpsychiatrist/
FOSSE, R., READ, J. (2013). Electroconvulsive treatment: Hypotheses about mechanisms of action. Frontiers in Psychiatry, 4, 94-103.
LEIKNES, K., SCHWEDER, L., HOIE, B. (2012). Contemporary use and practice of electroconvulsive therapy worldwide. Brain and Behavior, 2, 283-345.
READ, J. BENTALL, R., JOHNSTONE, L., FOSSE, R., BRACKEN, P. (2013). Electroconvulsive therapy. In J Read, J Dillon (eds.) Models of madness: Psychological, social and biological approaches to psychosis. London: Routledge, pp.90-104.
READ, J., BENTALL, R. (2010). The effectiveness of electroconvulsive therapy: A literature review. Epidemiology and Psychiatric Sciences, 19, 333-347.
SACKEIM, H., et al. (2007). The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology, 32, 244–254.
SHIWACH, R. et al. (2001). An analysis of reported deaths following electroconvulsive therapy in Texas, 1993-1998. Psychiatric Services, 52, 1095-1097.
SECOND LETTER: 16th February, 2016
Dear Minister Foley
Thank you for the (undated) letter to me signed by you, which I received yesterday (15.2.2016), in response to my email to you (4.2.2016) raising concerns about the lack of protection of the rights of people who use mental health services in Victoria.
Your letter refers me to the bodies that are indeed supposed to safeguard the rights of Victorian citizens when we use the State’s mental health services.
The letter completely ignores, however, the fact that my original email (attached again) informed you that these safeguards are not working, that they are broken and biased, and that they sometimes collude with psychiatrists even when they seem to be practising unethically, unscientifically and dangerously.
The fact that a psychiatrist has informed you that passing electricity though a person’s brain to cause a seizure (ECT) is ‘safe and effective’ does not make it so.
Did you have a chance, before responding, to read the research I sent you (attached again) which demonstrates that what is happening in the state of Victoria (at Upton House) is unscientific and dangerous? I think it is incumbent upon you, in your Ministerial role, to inform yourself fully rather than just relying on the personal opinions of one or two psychiatrists.
I repeat the key points – below – from my initial email, in the hope that you will take more seriously your responsibility as the senior representative of the government of Victoria on mental health issues. I hope you will respond more thoughtfully, in a way that addresses the rights of the people you have been elected to serve, including the right to be safe from having dangerous treatments forced upon them against their will (in this case 70 times consecutively), rather than being concerned with protecting the interests of one professional group, on whose advice you may, understandably, have become dependent.
I would be very happy to meet you and your staff if you would like to discuss the research relating to these issues.
I have tried to meet with the Chief Psychiatrist to do so but I was rebuffed (by an email remarkably similar to the one you have signed).
I asked the Chief Psychiatrist, two weeks ago, to send me the research supporting the bizarre claim, in his recently amended ECT Guidelines, that it is acceptable to start one series of ECTs immediately after another. I have never seen such a claim anywhere in the research literature, or in any other guidelines. Are the public supposed to believe this is a coincidence rather than a blatant attempt to provide some justification for the bizarre conduct of his colleagues, Drs Katz and Mackay at Upton House? I am still waiting for the research.
Are you comfortable, as Minister, presiding over a Chief Psychiatrist who publishes Guidelines, for professionals and patients, that do not refer to a single research study but are just a collection of personal opinions, some of them quite absurd?
Are you comfortable, as Minister, presiding over a Mental Health Tribunal that is blatantly biased to the point where its President (now under investigation following my formal complaints – see attached, again) takes guidance from Eastern Health’s lawyer while chairing a hearing, and the supposedly neutral psychiatrist on the panel actively and with no shame makes arguments on behalf of the psychiatrists seeking permission to forcibly give ECT to someone against their will?
Please, Minister, look into these issues – on behalf of the electorate in general and, in particular, on behalf of Victorians who, when using mental health services, are often in too vulnerable a position to stand up against these powerful professional vested interests and alliances.
KEY POINTS FROM MY FIRST EMAIL TO YOU (Feb 4 – attached again in full) WHICH A RESPONSIBLE MINISTER FOR MENTAL HEALTH CANNOT SIMULTANEOUSLY IGNORE (even if advised to do so by officials) AND REMAIN IN OFFICE:
“In conclusion, there seems to be little or no protection of the human or legal rights of people using mental health services in the State of Victoria. Some psychiatrists here seem able to conduct themselves in what most experts in the field would consider a potentially dangerous and unethical manner with no regard whatsoever for whether their actions have an evidence-base or are safe, while knowing that Eastern Health management and their colleagues on the Mental Health Tribunal and at the Office of the Chief Psychiatrist will do nothing to intervene however unprofessional their behaviour I am making this letter to you public in the hope that this may facilitate …. a full and genuinely independent investigation into the conduct of Dr Katz and other staff and managers at Upton House/Eastern Health, and into the complicity of senior members of the Mental Health Tribunal, and the Office of the Chief Psychiatrist, in knowingly allowing Dr Katz and his staff to continue to abuse their positions of trust and authority for such an extended period of time.”
I have to trust that either yourself, Minister, or somebody else in a position of authority, somewhere in the country, at state or federal level, from one political party or another, will grasp the importance of these issues for the wellbeing and safety of the Australian public.
Dr John Read
Professor, Clinical Psychology
Minister of Health, Victoria
Shadow Minister of Health, Victoria
Shadow Minister of Mental Health, Victoria
Ellen Sandell, MP – Melbourne, Victorian Greens
Rachel Carling Jenkins MP, Victoria
The Premier, Victoria
Leader of the Opposition, Victoria
Health Minister, Australia
Shadow Health Minister, Australia
Shadow Mental Health Minister, Australia
THIRD LETTER: 2nd March, 2016
Dear Minister Foley
I have not given up hope that you, or someone else with the authority to intervene, will eventually grasp, and act on, the grave failings in the State’s legally empowered systems for protecting the rights of people using our psychiatric services.
Here is a brief summary of some of their recent failings in relation to the tragic case of GD at Upton House, where unrestrained psychiatrists, operating with utter disregard of the relevant evidence bases, have administered over 50 consecutive ECTs and are now seeking permission from the Mental Health Tribunal to administer even more.
THE MENTAL HEALTH TRIBUNAL:
Investigated a formal complaint of blatant bias against the President (MC) and member Dr BM by having the Deputy President (TB) simply ask MC and BM whether they were guilty of the various allegations, but interviewing none of five witnesses present at the hearing in question (12.1.16) to actually determine whether my allegations were true. Verdict: complaint not upheld.
At a subsequent Tribunal hearing (18.2.16), during the period when MC and BM were being ‘investigated’ and were not on the panel, the decision was finally made to forbid the psychiatrists from administering further ECT on the grounds that it was, after all, not the ‘least restrictive’ approach (already appealed – see below). Since there had not been a new, less restrictive, treatment invented in the intervening month, this is proof that MC and BM had been wrong to condone the conduct of Eastern Health psychiatrists.
(The latest report of the MHT reveals that 92% of ECT hearings are decided in favour of the psychiatrist and against the patient)
OFFICE OF THE CHIEF PSYCHIATRIST:
Continues to simply ignore, for more than a month now, my request to see any research on which they are basing their various general claims in their official ECT Guidelines, or, specifically, any research that might justify the behaviour of the Upton House psychiatrists in continuing to administer ECT for months on end when it isn’t working, which the Office appears to condone. I conclude: (a) there is no such research, and (b) the Psychiatrists at the OCP do not adhere to the basic principles of evidence-based medicine.
Still has not denied my allegation that they rewrote the Guidelines, in December 2015, to provide the appearance of a rationale for the conduct of their fellow psychiatrists, by claiming that one series of ECT can begin immediately after another.
THE MENTAL HEALTH COMPLAINTS COMMISSION:
Dismissed my complaints against the Mental Health Tribunal and the Office of the Chief Psychiatrist on the grounds that they legally cannot investigate issues that have already been referred to these other agencies.
So I believe it falls on you Minister to initiate a full, genuinely independent investigation (ie not by psychiatrists) of the neutrality and efficacy of these agencies.
It also falls on you to intervene in the case in question. The response of the psychiatrists to being rebuffed by the Mental Health Tribunal on 18.2.2016 was to cancel the patient’s leave (denying him the opportunity to begin a long awaited vocational class, to resort again to tying him to his bed, and to apply to the Mental Health Tribunal to overturn their decision to uphold the patient’s right to refuse electric shocks. Yet another hearing has been scheduled, at very short notice, for tomorrow (3.2.2016).
Professor John Read
Cc: as for second letter