ECT, Forensics, Australia

Out on Pubmed, from researchers in Melbourne, Australia, is this responsive LTE::

The Mental Health Act (MHA) 2014 and the use of electroconvulsive therapy (ECT) in Victoria.
Das P, Jagadheesan K, Lakra V.Australas Psychiatry. 2020 Nov 9:1039856220970074. doi: 10.1177/1039856220970074. Online ahead of print.

The LTE is in response to:

Lee J, George K, Price L, et al. An evaluation of the practice of electroconvulsive therapy (ECT) in a Victorian health service before and after the Mental Health Act 2014. Australas Psychiatry 2020; 28: 279–285

From the text of the LTE:

A key finding of Lee et al. was a significant reduction in the total number of patients per month with the MHA 2014.1 We found a similar decline in ECT use, i.e. 14.83% reduction in ECT use per 1000 admissions and 19.91% reduction in the ECT of utilisation per 100,000 persons.2 Also, we found this reduction only in adult patients.2 Lee et al. wondered whether the mental health tribunal (MHT) process could have contributed to the decrease in compulsory ECT. We found the Victorian MHT to be time efficient.

 In our study, the mean age was higher for patients who received ECT in the year following the MHA 2014. We found the year of ECT treatment as the only significant negative predictor of compulsory ECT, which suggested the effect of the MHA 2014. The risk of compulsory ECT was positively predicted by past history of compulsory ECT, legal status at admission and discharge, and final Clinical global impression scale (CGI) score indicative of psychopathology. Both the studies1,2 have shown a reduction in ECT use following the MHA 2014 in Victoria. We do not know whether these changes are reflective of an adjustment phase to the new Act or reflective of a true change in ECT practice following the MHA 2014 that fundamentally promotes recovery and least restrictive practices.

This letter adds to the evidence base about the effects of specific government regulations on ECT practice. While the details may only be relevant to one state in Australia, the impact of mental health regulations is of general interest to all ECT practitioners around the world.

ECT is likely the most, or second most, regulated medical procedure in the world. Many regulations, while intended to protect patients' rights, are overly restrictive, and end up unethically limiting patient access to ECT. In some countries, the push for restrictive ECT legislation is spearheaded by members of the antipsychiatry movement who manage to dupe legislators into believing mischaracterizations of ECT.