4.4.1 The E.C.T. Workshop - Morning Session.

Ken and Pat welcomed everyone to the event, explained the role of both organisations and the purpose of the event, and stressed the need for everyone to listen to each others' views and respect each other's confidentiality.

Chris Dabbs, the Chief Officer of Salford C.H.C., then gave a brief presentation on the aims and objectives of the Project and the issues that had been highlighted to date. He was followed by Pat Butterfield and Andrew Bithell from E.C.T. Anonymous, a national support and pressure group for all E.C.T. survivors and their helpers. They gave their own views on E.C.T. and its use in the United Kingdom. The audience then asked a range of questions about E.C.T. and the Project.

Four discussion groups were then formed. Facilitation and the taking of notes were undertaken by a Member and officers of the C.H.C., members of Survivors in Salford and members of E.C.T. Anonymous. Each group was given a "prompt sheet" - a list of the issues thrown up by the Project Team's work to date - to help and inform their discussions.

Each group was asked to identify three issues that they wished to highlight to the representatives of the Mental Health Services of Salford N.H.S. Trust during the afternoon session. These were:

Change the law to give all patients a right to choose or refuse E.C.T.
All patients should have access to an advocate when offered E.C.T. and during a course of E.C.T.

All alternatives, especially talking treatments, should be offered before E.C.T. is considered.

Better long-term monitoring of patients after E.C.T. and long-term research into its effectiveness and side effects.

Concerns about E.C.T. particularly being given to older people and women - was there discrimination involved?

Health professionals to listen to patients and survivors more, both as individuals and as groups.

Better and more information for patients and relatives about E.C.T., with the maximum possible time being given to consider it before making a decision about whether to have E.C.T. This information should include views from psychiatrists and survivors, giving views both supporting and opposing E.C.T.

Greater distinction between physical and mental illness - some people reported being given E.C.T. for conditions that were physical and not mental.

To use only the most recent, up-to-date equipment for E.C.T., with this being tested and maintained on a frequent and regular basis.

A vegetarian lunch was served. During the lunch interval, survivors' poetry was performed by Survivors' Poetry Manchester.

4.4.2 The E.C.T. Workshop - Afternoon Session.

Dr. Steve Colgan and Ms. Avril Harding from the Mental Health Services of Salford N.H.S. Trust arrived at the start of the afternoon session. Chris Dabbs from the C.H.C. then presented the main issues highlighted by the discussion groups.

The question and answer session elicited the following responses from Dr. Colgan and Ms. Harding:

Most patients who are given E.C.T. without their consent are actually not able to give or withhold their consent.

There is a tension between seeking an absolute right to refuse E.C.T. and situations where the patient's judgement is impaired and they are suicidal.

The debate on the right to refuse E.C.T. needs wider moral and ethical discussion of the competing views.

Many patients at Meadowbrook were not aware of the independent advocacy service provided there by the Salford Mental Health Services Citizen's Advice Bureau. This service is not available to patients in the Elderly Service.

The main general risk with E.C.T. is that associated with repeated general anaesthesia.

E.C.T. is more commonly used in older people as they tend to respond well to E.C.T. and find drugs more noxious than younger people.

There is a need to listen more to and take more account of the views of patients.

Patients and carers should have as much information as they want about E.C.T. The Trust was developing a new leaflet on E.C.T.

The very high concurrence rate between the views of responsible medical officers (R.M.O.) and second opinion appointed doctors (S.O.A.D.) was because they were trained to the same standard.

The Trust recognises that there are still problems. It wants to continue to discuss the local service with survivors and carers in order to help make improvements.

The Trust was currently commissioning new E.C.T. equipment for the new E.C.T. Suite at Meadowbrook. Older E.C.T. were still being used, but were not considered dangerous and were maintained regularly and had not broken down since the new E.C.T. Suite had opened.

The period of time given to decide whether to give or withhold consent varies according to circumstances, but is as long as safe and possible.

It is recognised that one side effect of E.C.T. can be memory loss (at least in the short term). Long-term memory loss is rare and difficult to determine.

Compared to other alternative treatments, E.C.T. is better researched.

E.C.T. practice has improved over time, including in regard to machinery, anaesthetics, privacy and dignity.