Electroconvulsive therapy, known as ECT, is considered a ‘regulated treatment’ for the purposes of the Mental Health Act 2016 (Act).
ECT is defined in the Act to mean the application of electric current to specific areas of the head to produce a generalised seizure that is modified by general anaesthesia and the administration of a muscle relaxing agent for the treatment of a mental illness.
Because ECT is a regulated treatment, a doctor may perform ECT only in an Authorised Mental Health Service if:
- for a patient who is an adult:
- if the adult is unable to give informed consent to the treatment or is subject to a treatment authority, forensic order or treatment support order – the Mental Health Review Tribunal (Tribunal) has approved the performance of the therapy on the adult; or
- otherwise – the adult has given informed consent to the treatment; or
- for a patient who is a minor – the Tribunal has approved the performance of the therapy on the minor.
The person who is the subject of an ECT hearing is entitled to free legal representation which is arranged by the Tribunal.
In deciding whether to approve the treatment, the Tribunal must have regard to whether the adult is able to give informed consent to ECT and any views, wishes and preferences the adult has expressed about the therapy. If the application relates to a minor, the Tribunal must consider the views of the minor’s parents, and the views, wishes and preferences of the minor.
For an application, the Tribunal must be satisfied that the person the subject of the application is:
- an adult who is not able to give informed consent to ECT; or
- an adult who is able to give informed consent to ECT and is subject to a treatment authority, forensic order or treatment support order; or
- a minor.
The Tribunal may only give approval if satisfied:
- for an adult who is not able to give informed consent to ECT:
- the therapy has clinical merit and is appropriate in the circumstances;
- evidence supports the effectiveness of the therapy for the adult’s particular mental illness; and
- if the therapy has previously been performed on the adult – of the effectiveness of the therapy for the adult.
- for an adult able to give informed consent who is subject to a treatment authority, forensic order or treatment support order:
- the doctor has given the adult the explanation about ECT required by the Act; and
- the adult has given informed consent.
- for a minor:
- ECT has clinical merit and is appropriate in the circumstances; and
- evidence supports the effectiveness of the therapy for the minor’s particular mental illness and persons of the minor’s age; and
- if ECT has been previously performed on the minor – of the effectiveness of the therapy for the minor; and
- the performance of ECT on the minor is in the minor’s best interests.
Where approved, the Tribunal must state the number of treatments that may be performed in a certain period of time. The approval may also be made subject to conditions the Tribunal considers appropriate.
Emergency situations
ECT may also be performed for certain involuntary patients in emergency circumstances. In some circumstances, emergency ECT may be necessary to save the person’s life or to prevent the person from suffering irreparable harm. In these circumstances, the Act allows a doctor to administer emergency ECT in an Authorised Mental Health Service for:
- an involuntary patient subject to a treatment authority, forensic order or treatment support order; or
- a person absent without permission from another State who is detained in an Authorised Mental Health Service.
In this situation, ECT may be performed without the person’s consent if:
- the doctor and the senior medical administrator of the service certify in writing that performing ECT on the patient is necessary to save the relevant patient’s life or to prevent the relevant patient from suffering irreparable harm; and
- an application has been made to the Tribunal to perform ECT for the patient.
If ECT has been recommended for you, the best person to speak with is a member of your treating team.
Further information can be found on ECT in the treatment and care section of the Queensland Health website for the Act.