Dear Sirs,

Mental Health Bill: For the Consultation Process

I have been unable to access the area of the official website which contains the Draft Bill law, but my understanding is, the following is set to apply re.

'Electro-convulsive therapy (ECT) (Draft Bill clauses 118-120)'

"The Bill would allow ECT to be given without consent if it were expressly authorised by the Tribunal, or where it constituted urgent treatment. The Tribunal would be able to authorise ECT irrespective of whether the person had capacity to consent.

"The procedure for urgent treatment does not require prior approval and it allows two applications of the treatment. The treatment must be immediately necessary to save the patient's life, prevent a serious deterioration in his or her condition, alleviate serious suffering, or prevent violent behaviour or danger to self or others." (read this)

I write in order that it cannot be claimed the government is unaware of material implications of the proposals to give ECT to "prevent violent behaviour or danger to self or others." What clauses 118-120 actually indicate is the calculated intent to diminish with ECT a person's mental capacity to perform acts that the person would want to perform otherwise.

Consideration must be given to how ECT subdues the violent or restrains the dangerous. ECT is not direct physical restraint; it acts on the brain. Logically the only way a procedure that works on the brain could control and restrain is by its impact on mental capacity. In truth, no matter the ostensible reason for the prescription of ECT, an inherent capability to subdue exists in a procedure which constricts thinking ­ as when it diminishes the ability of recipients to entertain wishes or thoughts of death. (Prudic and Sackeim, 1999) Decreased thinking from ECT is what prevents violence to self.

Although the professionals say they lack knowledge of the mechanisms by which seizures alter mental functions, two prominent psychiatrists have categorically stated that ECT 'saves lives' (sic) by so contracting the ability to think suicidal recipients "are extremely unlikely, at least in the short term, to manifest suicidal ideation or intent." ('Electroconvulsive Therapy and Suicide Risk,' Prudic and Sackeim, J. Clin. Psychiatry 1999:60 (Suppl 2))

According to Professor Appleby, "The main aim of the proposed legislation is to improve safety for people who are at risk, particularly for patients themselves. Sometimes there are people who feel very suicidal but who in a legal sense still have capacity. We have to make sure that they receive the treatment they need." (read this) In consequence of the "wish to make sure that they receive the treatment they need" patients are to be subjected to a procedure which retards the mind. ECT's 'mind control' mode of action is decidedly questionable even as therapy, and in implying that people "need" mind control the government takes a less than reputable stance. High-flown rhetoric such as "improve safety...for patients themselves" fails to disguise the fact that a population who will be denied the rights and the effective means to defend themselves are to be cynically exploited.

As for danger to others, restrictions on freedom of expression (Article 10 of the ECHR) are permitted in the interests of public safety, but to slide into law a restriction that is effected through brain regulation is stretching things in relation to the Human Rights Act 1998. ECT contracts all thinking ­ and as action cannot occur if thought has been nullified so ECT also contracts the behavioural repertoire, to include aggressive acts. ECT given to subjugate an individual's mind in order that others might benefit is particularly questionable. There can be no recourse to the argument that this is therapy for the person thus treated, as is possible where safeguarding health by limiting someone's freedom of expression in suicide is concerned.

Psychiatrists are very aware of the importance of assuring the public that ECT is a soundly based treatment. The official (RCP) position on ECT for violent behaviour is that:

"There is no case for prescribing ECT to alleviate violent or offending behaviour per se. For a few patients who are suffering from a psychotic illness which has not quickly responded to antipsychotic medication, and where antisocial acts arise directly from psychosis, ECT may limit the acts by alleviating this." ('The ECT Handbook, 1995, p. 30)

Of particular note is the absence of evidence for ECT to "limit the acts" even in psychotic illness, as:

"Only one study seems to have made explicit a possible specific advantage for ECT for those with violent propensities. Smith et al (1967) noted that among people with schizophrenia the problems that responded most significantly and favourably to an ECT / chlorpromazine combination...were hostility (not violence) and ideas of persecution." (p. 30; emphasis added)

Of the Home Office / Department of Health conditions that will govern any decision to apply compulsion, concerning the 'appropriate treatment is available' condition, no basis for claiming patients would be protected from inappropriate treatment exists in circumstances lacking evidence of appropriateness (or even evidence the procedure is 'medical' in the accepted sense). (Para. 2.9) Clearly, anecdotal accounts referring to ECT which subdues, quieten, restrains, etc., drive ill-considered intent.

When it comes to the universally unpopular government diagnosis of DSPD, absence of clinical justification for ECT is glaringly apparent. Although DSPD isn't mentioned in the Draft Bill, violence and danger to others are, along with the proposals for ECT as a preventive measure irrespective of either capacity to consent or 'illness.'