The views and outcomes of consenting and non-consenting patients receiving ECT

1999 ◽  
Vol 29 (1) ◽  
pp. 221-223 ◽  
Author(s):  
T. J. WHEELDON ◽  
C. ROBERTSON ◽  
J. M. EAGLES ◽  
I. C. REID
Keyword(s):  
Mental Health ◽  
Informed Consent ◽  
Clinical Outcome ◽  
Medical Evaluation ◽  
Independent Medical Evaluation ◽  
Mental Health Legislation ◽  
Seriously Ill Patients ◽  
The Uk ◽  
Health Legislation ◽  
Seriously Ill

Background. Current mental health legislation in the UK makes provision for the use of certain treatments in severely ill patients who are unable, or unwilling, to give informed consent. Under the terms of this legislation, electroconvulsive therapy (ECT) may be used, usually to treat severely depressed patients. A number of organizations have challenged this practice, stating that ECT should only be given with fully informed consent: it has been implied that patients receiving compulsory ECT (given without the patient's consent, under the terms of mental health legislation) find the treatment damaging and unhelpful.Methods. A series of 150 patients receiving ECT in Aberdeen was studied. A proportion of the series (approximately 7%) received compulsory ECT. The views and treatment outcomes of compulsory patients were compared with those of patients giving informed consent for treatment.Results. More than 80% of patients in both consenting and compulsory groups considered ECT to have helped them. Clinical outcome did not differ between the groups. Patients' views showed marked concordance with independent medical evaluation of outcome.Conclusions. Outcome following ECT in non-consenting patients is equivalent to that seen in consenting patients whether rated by the patients themselves or by clinicians. Overall outcome is good, with more than 80% of patients benefiting from treatment. A ban on compulsory ECT would deny the access of seriously ill patients to an effective and acceptable treatment.

scholarly journals Information, consent and perceived coercion: patients' perspectives on electroconvulsive therapy

2005 ◽  
Vol 186 (1) ◽  
pp. 54-59 ◽  
Author(s):  
Dana S. Rose ◽  
Til H. Wykes ◽  
Jonathan P. Bindman ◽  
Pete S. Fleischmann
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Informed Consent ◽  
Electroconvulsive Therapy ◽  
Common Law ◽  
Sufficient Information ◽  
Compulsory Treatment ◽  
Perceived Coercion ◽  
Mental Health Legislation ◽  
Health Legislation

BackgroundElectroconvulsive therapy (ECT) is a procedure that attracts special safeguards under common law for voluntary patients and under both current and proposed mental health legislation, for those receiving compulsory treatment.AimsTo review patients' views on issues of information, consent and perceived coercion.MethodSeventeen papers and reports were identified that dealt with patients' views on information and consent in relation to ECT; 134 ‘testimonies' or first-hand accounts were identified. The papers and reports were subjected to a descriptive systematic review. The testimony data were analysed qualitatively.ResultsApproximately half the patients reported that they had received sufficient information about ECT and side-effects. Approximately a third did not feel they had freely consented to ECTeven when they had signed a consent form. Clinician-led research evaluates these findings to mean that patients trust their doctors, whereas user-led work evaluates similar findings as showing inadequacies in informed consent.ConclusionNeither current nor proposed safeguards for patients are sufficient to ensure informed consent with respect to ECT, at least in England and Wales.

scholarly journals A new legislative framework for mental capacity and mental health legislation in Northern Ireland: an analysis of the current proposals

2014 ◽  
pp. 84
Author(s):  
Maura McCallion ◽  
Ursula O'Hare
Keyword(s):  
Mental Health ◽  
Northern Ireland ◽  
Mental Capacity ◽  
Law Reform ◽  
Health Law ◽  
Mental Health Legislation ◽  
Legislative Framework ◽  
The Law ◽  
The Uk ◽  
Health Legislation

<p>When the Bamford Review of Mental Health and Learning Disability completed its work in the autumn of 2007, it drew to a close an extensive consultation and analysis of mental health and learning disability services and the law in Northern Ireland. Its last report on A Comprehensive Legislative Framework made<br />a compelling case for a major overhaul of the law that the Review team itself described as ‘quite radical’. The Review identified the case for reform in the need to ensure that mental health law conforms to the requirements of human rights law, reflects changes to professional practice, reflects the needs of service<br />users and their carers, and keeps pace with reform elsewhere in the UK. Alone of all the jurisdictions in the UK, Northern Ireland has been operating largely in a legislative vacuum in relation to mental capacity law. The Review’s proposals for reform therefore extended to reform of mental health law and the introduction of mental capacity law.</p><p>In the autumn of 2008 the NI Executive published its response to the Bamford Review indicating that it intended to develop the law sequentially: reform of the Mental Health (NI) Order 1986 by 2011 followed by the introduction of mental capacity law in 2014. Responses to the Executive’s consultation resulted in<br />the Department of Health Social Services and Public Safety (DHSSPS) revising its approach and it signalled its intention to bring forward mental capacity and mental health legislation together. This reated a unique opportunity in Northern Ireland for fusion of incapacity and mental health legislation. A further consultation paper was issued in January 2009, setting out the key approaches to the content<br />of two bills. However as a result of the consultation, the Health Minister Michael McGimpsey announced in September 2009 that there would be a single bill with an overall principle of autonomy. His press statement noted: “ A strong body of opinion, particularly from professional groups and lead voluntary organisations, which considered that separate mental health legislation continues to be stigmatising and recommended that mental capacity and mental health provisions should instead be encompassed into a single piece of legislation”</p><p>This short paper provides an overview of the current direction of travel on law reform in Northern Ireland. It comments on the policy climate and arguments for a fusion of mental capacity and mental health legislation. It also highlights some of the key policy issues that will need to be further explored as the Department develops its law reform proposals and concludes with some hopes and fears for the new legislation.</p>

scholarly journals In relative danger? The outcome of patients discharged by their nearest relative from sections 2 and 3 of the Mental Health Act

2003 ◽  
Vol 27 (02) ◽  
pp. 50-54
Author(s):  
Philip Shaw ◽  
Matthew Hotopf ◽  
Anthony Davies
Keyword(s):  
Mental Health ◽  
Clinical Outcome ◽  
Poor Clinical Outcome ◽  
Retrospective Case ◽  
Mental Health Act ◽  
Mental Health Legislation ◽  
Assessment And Treatment ◽  
The Right ◽  
Health Legislation ◽  
Control Cohort Study

Aims and Method Among the proposed changes in the current review of mental health legislation in England and Wales is the abolition of the right of the nearest relative to discharge patients from assessment and treatment orders (Sections 2 and 3 of the Mental Health Act 1983). We aimed to determine the clinical outcome of patients whose nearest relative applies for discharge. A retrospective case–control cohort study in a south London NHS Trust of 51 patients successfully discharged by their nearest relative and 33 patients whose nearest-relative applications were blocked by the treating psychiatrist on the grounds of ‘dangerousness'. Results Patients discharged from section by their nearest relative did not differ significantly from controls in all the measures of clinical outcome examined. Clinical Implications This study suggests that discharges by the nearest relative against psychiatric advice are not associated with a poor clinical outcome.

scholarly journals Different laws, same principles: mental health and incapacity legislation across the UK

2010 ◽  
Vol 16 (3) ◽  
pp. 158-160
Author(s):  
Donald Lyons
Keyword(s):  
Mental Health ◽  
Northern Ireland ◽  
Ethical Practice ◽  
England And Wales ◽  
Mental Health Legislation ◽  
Critical Issues ◽  
Care And Treatment ◽  
The Uk ◽  
Health Legislation

SummaryEngland and Wales, Scotland and Northern Ireland are all at different stages in developing their mental health legislation. All jurisdictions have encountered problems in interpretation and operation of the various acts. As an introduction to a series of articles to appear in Advances on mental health and incapacity law, this editorial offers a commentary on some of the critical issues and suggests some key principles that everyone should follow in order to provide care and treatment that accords with best legal and ethical practice.

The Role of the GP in United Kingdom Mental Health Legislation

2011 ◽  
Vol 4 (12) ◽  
pp. 675-684 ◽  
Author(s):  
Shona N. Bennett ◽  
Mark Harrison ◽  
Michelle Gilmore ◽  
Daniel M. Bennett
Keyword(s):  
Mental Health ◽  
United Kingdom ◽  
Northern Ireland ◽  
Mental Capacity ◽  
Legal Systems ◽  
England And Wales ◽  
Mental Health Legislation ◽  
The Uk ◽  
Health Legislation

GPs may be required to assist in the administration of Mental Health or Mental Capacity Legislation. Although infrequent, this process can be complicated and time consuming. Due to different legal systems, the role of the GP in civil commitment varies considerably throughout the UK. This article aims to give a brief overview of the main pieces of legislation in the different areas of the UK, England and Wales, Scotland and Northern Ireland, and to assist the GP in navigating the practicalities of applying the law to clinical cases.

scholarly journals Mental health legislation in Japan and the UK

1992 ◽  
Vol 16 (4) ◽  
pp. 234-235
Author(s):  
Naresh Gandhi ◽  
Ian Treasaden
Keyword(s):  
Mental Health ◽  
Mental Health Legislation ◽  
The Uk ◽  
Health Legislation

scholarly journals Proportionality of legal discrimination

2010 ◽  
Vol 7 (1) ◽  
pp. 24-24
Author(s):  
Partha Gangopadhyay
Keyword(s):  
Mental Health ◽  
Code Of Practice ◽  
Department Of Health ◽  
Mental Health Legislation ◽  
Mental Capacity Act 2005 ◽  
Legal Duty ◽  
The Government ◽  
Mental Capacity Act ◽  
The Uk ◽  
Health Legislation

Sir: The article by Zigmond (2009) made for interesting reading. Mental health law is about balancing the need to detain people in order to protect them or other people from harm and the need to respect people's human rights and autonomy. In the UK, there was much concern during the development of recent mental health legislation, in particular the Mental Capacity Act 2005, that the government had got this balance wrong. Many of these concerns have been addressed in the updated Code of Practice to the 1983 Mental Health Act, which is an essential guide to practising under the Act (Department of Health, 2008). There is no legal duty to comply with the Code, but professionals must have regard to it and record the reason for any departure from the guidance (which can be subject to legal challenge).

scholarly journals Changing mental health legislation in the UK

2008 ◽  
Vol 14 (2) ◽  
pp. 81-83 ◽  
Author(s):  
Tony Zigmond
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
England And Wales ◽  
Mental Health Act ◽  
Mental Health Legislation ◽  
Care And Treatment ◽  
The Uk ◽  
Health Legislation

Following devolution, the mental health acts of the constituent countries of the UK are diverging in their provisions. This editorial describes three significant differences between the new Mental Health (Care and Treatment) (Scotland) Act 2003, which came into effect in Scotland in 2005, and the Mental Health Act 2007 for England and Wales.

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