Statements

100% compliance on Electroconvulsive Therapy regulations

There was an overall decrease in the administration of electro-convulsive therapy (ECT) in Irish mental health centres in 2021. There was also full compliance to the rules and code of practice relevant to ECT at the approved centres administering the therapy, according to a report published by the Mental Health Commission (MHC) today.

The report, titled ‘The Administration of Electro-convulsive Therapy in Approved Centres: Activity Report 2021’, provides information on how often ECT is used, the people who receive it, the services providing it, and the quality and safety of the service. It is the twelfth annual activity report published by the MHC on the use of ECT in approved mental health centres and includes previously published 2020 and 2019 data for comparative purposes.

“The purpose of publishing this report is to provide an assurance to the public that this medical procedure is regulated and monitored by the MHC,” said the Director of Regulation for the Mental Health Commission, Gary Kiernan. “Transparency about levels of compliance with the rules and codes of practice governing the administration of ECT is critical. This year it is encouraging to report that there has been 100% compliance with the regulatory requirements for administering the treatment.”

Programmes of ECT

This year, the report shows that there were 293 programmes of ECT administered to 219 residents in 2021. This represents a decrease on figures from 2020, which saw 300 programmes of ECT administered to 239 residents. In addition, there was a total of 2,281 individual treatments of ECT administered in 2021, representing a small decrease of 2% compared to 2020, when 2,329 individual treatments were administered.

A programme of ECT refers to no more than 12 treatments of ECT prescribed by a consultant psychiatrist, with the total number of treatments administered in a programme of ECT varying from one to 12 treatments. The report shows that a majority of residents were administered one programme of ECT (74% in 2021 and 70% in 2020.)

The report shows that all relevant services (100%) were compliant with the Code of Practice on the Use of ECT in 2021, an increase from 86% compliance in 2020.

Reasons for ECT and outcomes

Mood disorders[1] (including depression) were reported as a diagnosis for 87% of residents who were administered ECT in 2021, compared to 80% of residents in 2020. Refractory (resistance) to medication was the most common single indication for ECT, accounting for 62% of programmes (181) in 2021, and 64% (193) in 2020. Improvement was reported as the outcome in 87% of programmes of ECT (256) in 2021, compared to 63% in 2020 (189). Outcome information was not provided for 11 programmes (4%) in 2021.

Profile of those receiving ECT

In 2021, the average age of all residents who were administered ECT was 65 years, an increase from an average of 62 years in 2020. In 2021, residents receiving ECT ranged in age from 23 to 94 years, compared to 25 to 93 years in 2020.

Data from recent years indicate that female residents are more likely to be administered ECT than males. Fifty-nine percent (59%) of ECT residents in 2021 were female. The higher ratio of female to male ECT recipients may reflect the relatively higher incidence of depressive illness in women as compared with men.

Consent

In 2021, 87% of ECT treatments (1,985) were administered with consent, and 13% (296) were administered without consent. In 2020, 81% of treatments (1,881) were administered with consent, and 19% of treatments (442) were administered without consent Last year, 15% of ECT programmes (43) involved one or more treatments without consent, compared to 19% (59) of programmes in 2020. MHC rules governing the use of ECT therapy deal with the issue of consent to treatment and provide a series of safeguards for situations where the patient is unable to consent

2021 key statistics on ECT:

  • 293 programmes of ECT were administered to 219 residents in 2021 (2020: 300 programmes to 286 residents)
  • The rate of ECT programmes per resident was 1.3 programmes in both 2021 and 2020.
  • 74% of residents who received ECT were administered one programme of ECT (2020: 70%)
  • The average number of treatments per programme was 7.8 in both 2021 and 2020.
  • There was a total of 2,281 individual treatments of ECT administered in 2021 (2020: 2,329).
  • In 2021, 100% of relevant services were compliant with all aspects of the rules governing the use of ECT; this was an increase from 86% compliance of relevant services in 2020.
  • In 2021, 82% of residents were admitted on a voluntary basis when they commenced their programme of ECT, compared to 78% in 2020.
  • Acute Psychiatric Unit, Tallaght University Hospital reported the highest number of programmes of ECT in a HSE-operated service in 2021 (32), 2020 (23) and 2019 (38); an average of 31 ECT programmes each year. In comparison, the average number of ECT programmes per year across each of the other HSE services was eight.
  • In relation to the Independent Services, St Patrick’s University Hospital, a large 241-bed and ECTAS-accredited service, accounted for 54% of all programmes (157) in 2021. Similarly, the approved centre accounted for 53% and 50% of programmes in 2020 and 2019 respectively.

[1] Mood (affective) disorders involve a change in mood either to depression (with or without anxiety) or to elation. The mood change is usually accompanied by a change in overall level of activity. Mood disorders tend to be recurrent and the onset of individual episodes can often be related to stressful events or situations (ICD-10, 2019).

You can read our full statement here. 

The Administration of Electro-convulsive Therapy in Approved Centres: Activity Report 2021

Back to News