Electroconvulsive treatment

Electroconvulsive treatment (ECT) is a safe and effective treatmentfor some mental illness, particularly severe depression and other mooddisorders.

Adults receiving mental health services (whether on a voluntary or compulsory basis) can give informed consent for ECT. For patients who do not have capacity to give informed consent, the authorised psychiatrist applies to the Mental Health Tribunal to approve the ECT.

The Mental Health Tribunal will determine applications to performECT on all people under 18 years of age, regardless of whether theyoung person is a patient or is receiving voluntary treatment.

What is ECT?

ECT is a medical procedure in which a person’s brain is stimulatedwith a brief, controlled series of electrical pulses using electrodesplaced at precise locations on the person’s head. This stimulus causes aseizure within the brain. ECT is always performed under generalanaesthetic and with a muscle relaxant, which prevents the person fromfeeling any pain and prevents the person’s body from convulsing.

A course of ECT can be up to 12 treatments performed over a period of time that cannot exceed six months.

ECT for adults - consent

An adult receiving voluntary mental health services may give informed consent to ECT and receive the treatment.

Any adult patient may also give informed consent to ECT andreceive the treatment, if they have capacity to give informed consent.

All patients must be presumed to have capacityto give informed consent unless it can be demonstrated that the personlacks capacity at the time the decision needs to be made.

If an adult patient does not have capacity to give informedconsent, ECT may only be performed on the patient with the approval ofthe Mental Health Tribunal following an application by an authorised psychiatrist.

The Tribunal may only approve ECT if it is satisfied that:

• the patient does not have capacity to give informed consent
• there is no less restrictive way for the patient to be treated.

Determining ‘least restrictive’ treatment

In determining whether there is no less restrictive way for an adult patient to be treated, the Tribunal must consider:

• the patient’s views and preferences about ECT, including views expressed in an advance statement
• the views of other significant people such as the nominated person, a guardian of the patient or a carer, if the authorised psychiatrist is satisfied that the decision to perform ECT will affect the carer and the care relationship
• the likely consequences for the patient if ECT is not performed
• any second psychiatric opinion that has been given to the authorised psychiatrist.

ECT for young people - consent

ECT is rarely given to people under the age of 18 years but may be clinically indicated in limited circumstances.

When ECT is used, it must be approved by the Mental HealthTribunal, regardless of whether the young person or their parent givesinformed consent.

Young patients

An authorised psychiatrist may apply to the Tribunal for approvalto perform ECT on a young person who is a patient of a mental healthservice if the young person:

• has given informed consent
• is unable to give informed consent and the authorised psychiatrist is satisfied there is no less restrictive way for the young patient to be treated.

ECT cannot be performed on a young patient without Tribunal approval.

If the Tribunal finds that a young patient has capacity to consentto ECT and has given informed consent to the ECT, the Tribunal mustapprove the performance of ECT.

The Tribunal cannot approve ECT if a young patient has capacity and refuses to consent to ECT.

If the Tribunal finds that a young patient does not have capacityto give informed consent to ECT, it may only approve ECT if it issatisfied that there is no less restrictive way for the young patientto be treated.

Young persons who are not patients

An authorised psychiatrist or treating psychiatrist may apply tothe Tribunal for approval to perform ECT on a young person who is not apatient if:

• the young person has given informed consent
• if the young person is unable to give informed consent, a parent or guardian has given informed consent to ECT.

ECT cannot be performed unless the Tribunal approves.

If the Tribunal finds that a young person has capacity to consentto ECT and has given informed consent to ECT, the Tribunal must approvean application to perform ECT. The Tribunal cannot approve ECT if ayoung person has capacity and refuses to consent to ECT.

If the Tribunal finds that a young person does not have capacityto give informed consent to ECT, it may only approve ECT if it issatisfied a parent or guardian has consented and there is no lessrestrictive way for the young person to be treated.

Determining ‘least restrictive’ treatment

In determining whether there is no less restrictive way for ayoung person or young patient to be treated, the Tribunal mustconsider:

• the young person or young patient’s views and preferences about ECT including any views expressed in an advance statement
• the views of other significant people such as -
  • the nominated person
  • a carer, if the authorised psychiatrist is satisfied that the decision to perform ECT will affect the carer and the care relationship
  • a parent, if the young person or young patient is under the age of 16 years
  • a person who has legal authority to consent to treatment for the young person or young patient
  • the Secretary to the Department of Human Services if the young person or young patient is subject to a custody to Secretary order or guardianship to Secretary order
• the likely consequences for the young person or young patient if ECT is not performed
• any second psychiatric opinion that has been given to the authorised psychiatrist.

Urgent ECT

In some cases ECT is needed urgently to save a person’s life,prevent serious damage to a person’s health or prevent continuedsignificant pain or distress.

In such cases, the psychiatrist may request that a hearing be listed urgently by the Tribunal.

Mental Health Tribunal hearings for ECT

ECT applications are heard and determined by the special division of the Tribunal.

The special division comprises three members: a lawyer, a psychiatrist and a community member.

The patient or young person can attend the hearing and be represented by anyone of their choice, including a lawyer.

The Tribunal takes a holistic approach when it makes decisions. Itconsiders a range of factors including the patient or young person’sgoals and preferences and the views of people who are significant inthe life of the person, such as the nominated person, carers andparents.

The Tribunal conducts hearings as promptly and with as littleformality and technicality as possible. At the end of the hearing, theTribunal gives its decision and reasons for the decision.