Electroconvulsive Therapy Policy

Policy Statement

Electro-convulsive therapy (ECT) involves the passage of an electrical current through the brain of a patient to produce a grand mal seizure.

ECT has been used to treat behaviour issues and depression in people with developmental disabilities. While studies have been done on the effectiveness of ECT, the risks and benefits of ECT specific for people with developmental disabilities are unknown. The decision to apply ECT is often made before all other options are sufficiently explored. The result is an invasive treatment as opposed to something less intrusive that addresses the cause of the behavior problem or depression. Because the risks involved with ECT to people with developmental disabilities are unknown, BCACL considers this treatment experimental.

While there are some protections in the Health Care (Consent) Care Facility (Admission) Act, legislation continues to leave people with developmental disabilities vulnerable to this intrusive treatment.

Consent to Electro-convulsive Therapy (ECT) by a temporary substitute decision maker is covered under the Health Care (Consent) Care Facility (Admission) Act, section 18. Under the Health Care Consent Regulation, section 5, any temporary substitute decision maker making a decision to consent to ECT on behalf of an adult who is incapable of making that health care decision, must have a written recommendation from two physicians. In addition, the treating physician is required to contact the Community Legal Assistance Society (CLAS). ECT is considered major health care and therefore is subject to the 72 hour review period before the treatment can be given.

The consent provisions of the Health Care Consent Act do not apply to anyone certified under the Mental Health Act receiving psychiatric treatment. Therefore the decision to provide an adult who is certified under the Mental Health Act with ECT is the decision of the treating physician. While the adult and family may be consulted in the decision, consent is not required for ECT or any other psychiatric treatment. Notification of CLAS and the 72 hour review period before commencing treatment does not apply.

Purpose

• To ensure that people with developmental disabilities are not given ECT.
• To raise awareness on the potential risks of ECT to people with developmental disabilities.

Background

• The patients rights’ movement has led to renewed attention and interest in the risks of ECT. These include significant permanent memory impairment, brain damage, and in some cases, death.
• ECT use is on the rise on British Columbia. Riverview Hospital’s ECT program has shown a yearly increase in use, especially dramatic in the elderly patient population. Nationally, the use of ECT has doubled in the last decade.
• Some research indicates that ECT is applied in a highly selective manner; that it is more likely to be prescribed where the patient is institutionalized, is an elderly female or has a developmental disability.

Policy Statements

1. BCACL does not support ECT for people with developmental disabilities.
2. For the purposes of administering ECT, the Mental Health Act should not override the Health Care (Consent) Care Facility (Admission) Act for people with developmental disabilities who have a co-existing mental health diagnosis.