ECT Administered to 239 residents in 2020

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There were 300 programmes of ECT administered to 239 residents in approved centres in 2020, according to the latest report of the Mental Health Commission. 

This compared to 395 programmes of ECT administered to 286 residents in 2019.

“The Administration of Electro-Convulsive Therapy  in Approved Centres for the year 2020,” said a programme of ECT may involve up to 12 individual treatments of ECT. The average number of treatments per programme was 7.8 in 2020, compared to 7.9 in 2019.

The rate of ECT programmes per resident was 1.3 programmes in 2020 and 1.4 programmes in 2019.

In 2020, 70% of residents who received ECT were  administered one programme of ECT, a decrease from 73% in 2019.

A total of 2,329 individual treatments of ECT were administered in 2020, a 25% decrease in comparison to 2019 (3,124).

Fourteen approved centres (23%) provided an ECT service in 2020. A further five approved centres (8%) reported that they  referred residents to another approved centre for ECT treatment in 2020. 

The average age of all residents who were administered ECT was 62 years and the age range was 25 to 93 years.

Mood disorders (including depression) were reported as a diagnosis for 80% of residents who were administered ECT in 2020.

More females than males received ECT, at a ratio of approximately two-thirds to one-third respectively. The report said the higher ratio of female to male ECT recipients may reflect the relatively higher incidence of depressive illness in women as compared with men.

In 2020, 78% of residents had been admitted on a voluntary basis when they commenced their programme of ECT, compared to 82% in 2019.

In 2020, 81% of ECT treatments (1,881) were administered with consent, and 19% (442) were administered without consent. Five per cent of residents (16) withdrew consent during the course of their programme of ECT.

Following implementation of the Mental Health (Amendment) Act 2015, ECT may be administered to an involuntary patient without consent, only where it has been determined that the patient is unable to consent to the treatment.

Mood disorders (including depressive and manic disorders) were reported as a diagnosis for 80% of residents who were administered ECT in 2020, followed by 12% with a diagnosis of schizophrenic, schizotypal and delusional disorders (37). The least common diagnoses have been personality and behavioural disorders, and organic disorders.  This is in keeping with other jurisdictions, as depressive disorders are the most common indication for ECT internationally.

Refractory to medication was the most common single indication for ECT, accounting for 64% of indications. Maintenance ECT and Rapid response required accounted for the second most common indications, at 13% each.

Improvement was reported as the outcome in 86% of programmes of ECT in 2020, lower than in 2019 (87%) and 2018 (92%).

Much Improved or Very much Improved was reported as the outcome for 72% of ECT programmes in 2020, 14% of respondents reported being Minimally Improved,  9% of programmes reported no change.

Programmes with a negative outcome of Minimally Worse, Much Worse or Very Much Worse accounted for only 1% of programmes in 2020.

In 2020, 77% of relevant services (those administering ECT to involuntary patients) were compliant with all aspects of the Rules Governing the Use of ECT, an increase from 61% compliance in 2019.

In 2020, 86% of relevant services were compliant with all aspects of the Code of Practice on the Use of ECT, an increase from 81% compliance in 2019.

The ECT Accreditation Scheme (ECTAS) was established in 2003 by the Royal College of Psychiatrists to support quality improvement of ECT clinics in both Ireland and the UK. The ECTAS standards have been developed for the purposes of review and accreditation of ECT centres.  There is also a guide for new or developing ECT services (Royal College of Psychiatrists, 2020  Three ECTAS-accredited centres in Ireland delivered 64% of ECT programmes in 2020.

While the MHC does not require approved centres to be ECTAS accredited in order to carry out ECT treatment, ECTAS is nevertheless recognised by the MHC as best practice, and all approved centres are encouraged to become ECTAS accredited in the future.

This report has been issued 12 years after the publication of the first annual Report on the Use of Electroconvulsive Therapy in Approved Centres in 2008 (2009).

Involuntary admissions have increased year-on-year from 2,004 to 2,463 over the twelve-year period, between the years 2008 and 2020, while total admissions have fallen considerably, from 20,752 at the highest in 2008 to 15,391 at the lowest in 2020.