1. Key changes to ECT Dr. Rafael Euba

2. Main Change 7 Electro-Convulsive Therapy

3. ECT – section 58a • Adults with capacity can refuse to accept ECT treatment even if they are detained under the Act • Where an adult lacks capacity, this assessment must be agreed by a SOAD who must also confirm that ECT would be appropriate • The SOAD must also confirm that there is no valid advance decision regarding ECT

4. Section 62 – emergency treatment • Section 62 continues to allow ECT treatment in an emergency • However, clinicians will be expected to take account of the views expressed by patients with regard to ECT, and any Advance Decision they have made

5. So • No ECT in the face of a refusal with capacity • ECT given under MHA in those who lack capacity and do not resist • Require second opinion for those under 18

6. Special treatment status • Has special status under section 58 making it a special treatment under the MHA which requires consent or a second opinion

7. Critique • We do not think we ever gave ECT to those who had the capacity to refuse it. A psychotic depression causes capacity to be compromised and if ECT is imposed, then that person lacked capacity • Good practice to write down your assessment in terms of a capacity assessment and record that and to continue reviewing capacity and consent during the course of treatment

8. Update on ECT • Current dosing regime;- stimulus dosing, minimum charge for maximum effect • Monitor response and adjust according to response • Anaesthetic = propofol so shorter seizures

9. Memory and reversible changes • Biographical memory impairment is reversible (within 3 months or so), but there is some evidence that for a minority of patients there may be some permanent changes. • Almost all resolves within 3 months

10. How to do it • Good assessment • Use ECT pack • Rate severity of illness • Prescribing clinician share responsibility with the administering clinician • Done in an accredited centre