3.11.2 Information and Explanations.

In 1996, the Trust reported that "there is no written information given to patients regarding E.C.T. E.C.T. is individually discussed with each client by the doctor prescribing it. It is also backed up with discussions by nursing staff and also by E.C.T. staff when then patient first comes for treatment."

Clinical staff also told the Project Team that information for patients and the obtaining of consent to treatment was not standardised within the Trust.

During discussions with clinical staff in the Trust, the Project Team was told that no written information is given to patients about E.C.T. At present, the only explanation for E.C.T. was verbal. All information is given verbally, and is thus dependent on staff, their communication skills and the way in which the information is presented. A new form and set of criteria were required. It was noted that the Royal College of Psychiatrists had produced videos illustrating "ideal interviews".

At the time of the visit to the E.C.T. Suite at Meadowbrook on 27 October, 1997, the C.H.C. team was told that patients should be given the Royal College of Psychiatrists' leaflet by ward staff, although this was probably more likely to be on request than automatic.

This situation was in contrast to that when Salford C.H.C. enquired about this in 1994, when it was provided with a copy of the Royal College of Psychiatrists E.C.T. (Electroconvulsive Therapy) A Factsheet for You and Your Family dated 12 July, 1993, and marked for the Meadowbrook Department of Psychiatry of the Mental Health Services of Salford.

The Trust indicated that the information as suggested by Mind "would be very useful for patients or their relatives to ask about E.C.T. These reports of survivors and the comments about validity of consent make disturbing reading and should be read by doctors prescribing E.C.T. . . . We will explore with the staff administering E.C.T. the development of a small pamphlet addressing these questions and providing some written information." (Hyde, 1997: 6).

3.11.3 Validity of Consent.

The process of obtaining valid consent from a patient is based on the clinical judgement of their responsible medical officer (R.M.O.). If they and the clinical team consider that a course of E.C.T. treatments would be beneficial, this should be discussed with the patient and, where appropriate, their relatives. Under the Patient's Charter, patients should be given a full explanation, including about the benefits, risks and alternatives. Nursing staff can have an important role in this process. The Trust is expected by the local Health Authority to audit and report on performance against this standard.

The Trust includes obtaining valid consent as an integral part of its Mental Health Act training updates.

The Project Team was informed by Trust staff that there is no independent advocacy available to patients who are offered or given E.C.T.

3.11.4 E.C.T. Without Consent.

The Project Team was told by Trust staff that treatment without consent is monitored by the Mental Health Act Commission, including against the Mental Health Act Code of Practice.

4. Patients', Users and Survivors' Views in Salford.

4.1 Background.

The Project Team tried several different approaches to obtaining the views of survivors of E.C.T. from the start of the Project. These included press releases, articles in local press and media (including voluntary sector and mental health publications), and direct letters and mailings to mental health user groups and carers' organisations. These yielded, however, only two people, both of whom were coopted onto the Project Team.
The Project Team felt it vital that every effort was made to obtain the views of people who had had E.C.T. in Salford. It therefore met with Survivors in Salford, the only city-wide organisation of mental health service users to discuss possible ways forward. From this discussion, it was agreed to hold a workshop and to invite survivors, users and carers to come to give their views. This was a format that had been used successfully by Survivors in Salford before on other mental health issues.

4.2 Planning and Publicity.

The workshop was promoted and publicised through the press and media (including articles in local newspapers and interviews on B.B.C. local radio), and through the distribution of 1 500 flyers targeted at survivors through user groups, carers' groups, community psychiatric nurses, health centres, social workers, support workers, drop-ins and libraries. The mailing list for Marooned?, the mental health magazine for Salford, and the Salford Council for Voluntary Service Directory of Local Information were used to assist with distribution. The flyers included information about lunch and the reimbursement of travel expenses.