ECT administration drops and compliance increases, according to Mental Health Commission

There was an overall decrease in the administration of electro-convulsive therapy (ECT) in Irish mental health centres in 2020, while overall compliance to the rules and code of practice relevant to ECT increased, according to a report published by the Mental Health Commission (MHC) this morning.

The report, titled ‘The Administration of Electro-convulsive Therapy in Approved Centres: Activity Report 2020’, 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 eleventh annual activity report published by the MHC on the use of ECT in approved mental health centres and includes previously published 2018 and 2019 data for comparative purposes.

This year, the report shows that there were 300 programmes of ECT administered to 239 residents in 2020. This represents a decrease on figures from 2019, which saw 395 programmes of ECT administered to 286 residents. In addition, there was a total of 2,329 individual treatments of ECT administered in 2020, representing a 25% decrease in comparison to 2019, when 3,124 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 the majority of residents were administered one programme of ECT (70% in 2020 and 73% in 2019). In 2020, 22% of residents were administered two programmes of ECT, followed by 8% being administered three or more programmes. In 2019, 16% of residents were administered two programmes of ECT, followed by 12% being administered three or more programmes.

The report also shows that 77% of relevant services (those administering ECT to involuntary patients) were compliant with all aspects of the rules governing the use of ECT in 2020 - an increase in compliance of 16% from 2019 - while 86% of relevant services in 2020 were compliant with all aspects of the Code of Practice governing the use of ECT, an increase on service compliance by 5% compared to 2019 figures.

Mood disorders were reported as a diagnosis for 80% of residents who were administered ECT in 2020, with the same diagnosis accounting for 85% in 2019. Refractory (resistance) to medication was the most common single indication for ECT, accounting for 64% of programmes (193) in 2020, and 66% (259) in 2019. Improvement was reported as the outcome in 63% of programmes of ECT (189) in 2020, compared to 76% in 2019 (299).

“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. “The report also provides transparency about levels of compliance with the rules and codes of practice governing the administration of ECT. While the increase in compliance in 2020 is very welcome, we would encourage service providers to closely monitor their compliance and improvement initiatives in this area.”

During 2020, residents receiving ECT ranged in age from 25 to 93 years of age - compared to 22 to 89 years of age in 2019 - and the average age of all residents who were administered ECT was 62 years of age, a slight increase from an average of 59 years of age in 2019.

In both 2020 and 2019, more females than males received ECT, at a ratio of approximately two-thirds to one-third respectively. This was also the case in 2018. The higher ratio of female to male ECT recipients may be reflective of the relatively higher incidence of depressive illness in women as compared with men.

In 2020, 81% of ECT treatments (1,881) were administered with consent, and 19% (442) were administered without consent. In 2019, 84% of treatments (2,621) were administered with consent, and 16% of treatments (516) were administered without consent. In total, 19% of programmes of ECT (59) in 2020 involved one or more treatments without consent, compared to 16% (62) in 2019.  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.

 

2020 key statistics on ECT:

 

• 300 programmes of ECT were administered to 239 residents in 2019 (2019: 395 programmes to 286 residents)
• Rate of ECT programmes per resident was 1.3 programmes per resident in 2019 (2019: 1.4)
• 70% of residents who received ECT were administered one programme of ECT (2019: 73%)
• The average number of treatments per programme was 7.8 in 2019, as compared with 7.9 in 2019.
• There was a total of 2,329 individual treatments of ECT administered in 2020 (2019: 3,124).
• In 2020, 77% of relevant services were compliant with all aspects of the rules governing the use of ECT; this was an increase from 61% compliance of relevant services in 2019.
• 86% of relevant services in 2020 were compliant with all aspects of the Code of Practice governing the use of ECT, an increase on service compliance in 2019 (81%).
• The Acute Psychiatric Unit at Tallaght University Hospital reported the highest number of programmes of ECT (23) in a HSE-operated service in 2020.
• In relation to the independent services, St. Patrick’s University Hospital accounted for 53% of all programmes (159) in 2020. It should be noted that St Patrick’s has an arrangement with the HSE for the admission of residents for ECT treatment. As part of this arrangement, residents are admitted to St Patrick’s and therefore all such programmes are reported under this service’s figures.

In early 2020, the MHC initiated a roll-out its online Comprehensive Information System (CIS) ECT function which was aimed at gathering better data about the use of ECT in approved centres. The system was piloted with two services - St Patrick’s University Hospital and the Acute Psychiatric Unit at Tallaght University Hospital. The implementation of the CIS ECT function alters the obligation on approved centres from providing an annual data return of all programmes of ECT, to a contemporaneous data entry for each ECT treatment. For future ECT activity reports, annual data returns will no longer be required from approved centres.

You can read our full statement here. 

The Administration of Electro-convulsive Therapy in Approved Centres: Activity Report 2020