Mental Health Bill [HL]

I also support Amendment No. 15, tabled in the name of the noble Earl, Lord Howe, and will limit my remarks to the giving of ECT to people under 18. I too was asked to table an amendment that would have banned the giving of ECT to young people in any circumstances, but, having studied the research evidence on the subject, and from my own personal experience of patients who have undergone ECT, I was not persuaded that that was the right course of action. The Howe amendment, on the other hand, allows ECT to be given to young people in extremis, and for me the evidence to date supports that. The British Psychological Society document Depression in Children and Young People provides a valuable review of the giving of ECT to young people. There are significant concerns about the adverse effects of ECT; as other noble Lords have said, it may cause short- or long-term memory impairment for both past and current events, and those risks may be enhanced in children and young people, that being the crucial point for me in this short debate. NICE also concludes that there is insufficient information to allow appropriate risk-benefit assessment for children and young people. For both reasons, NICE recommends that clinicians should exercise particular caution when considering ECT treatment in that group. The amendment ensures that clinicians will comply with the NICE guidance, which is a sensible measure for this Committee to ensure. The recommendations of the American Academy of Child and Adolescent Psychiatry in 2002 are also a helpful guide to practice. If ECT is to be given, a number of conditions should apply. The following three are absolutely central, and the noble Earl’s amendment is designed to ensure that these conditions are met at all times. First: "““The symptoms must be severe, persistent and significantly disabling, including life-threatening symptoms such as refusal to eat or drink, severe suicidality, or florid psychosis””." Secondly: "““Other treatments should have been tried and failed, including at least two or more trials of appropriate psychopharmacology, unless the severity of symptoms precludes waiting for a response to other treatments””." And thirdly: "““A psychiatrist experienced in the use of ECT, but not involved in the case, should give a second opinion””." In May 2003 NICE published its guidance on ECT for depressive illness, schizophrenia, catatonia and mania. NICE follows a similar line to the American Academy, and recommends that ECT, "““is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening””." The draft Mental Health Bill published on 8 September 2004, as others have referred to, provided for very stringent safeguards. For some reason, those have now been lost. This amendment would at least go some way towards restoring them; it is less stringent, but I think it would achieve the desired objective. If there are insufficient data on the long-term effects of ECT, and if it is known to carry risks, why not ban it? We can turn to the views of young people who have been given ECT and their parents to provide part of the answer to that question. Three studies, undertaken in 1999 and 2000, of a total of 64 young people who had received ECT and their parents found that a small majority of the young people believed the treatment had been helpful. Most had experienced memory loss—one of the major concerns about ECT, as we know—but ““this had largely resolved over time””. A further study, undertaken in 1999, of 87 patients with depression who had been treated with ECT aged 18 years or younger showed that 67 per cent had remitted or showed marked improvement of symptoms after treatment. I just do not think we can ignore the experience of people who have been through the treatment. We are concerned here with a very small number of the most severely mentally ill, as others have said. Richard Duffett, consultant psychiatrist at Goodmayes Hospital, provides us with, as far as I know, the only statistics available. As the noble Baroness, Lady Murphy, has quoted, he gives a figure of some 12 cases a year. The amendment will guarantee the safeguards necessary to ensure that ECT continues to be given to only a small number of young people with exceptionally severe mental health problems. I hope the Minister will give sympathetic support to this important amendment.