Presentation on Proposal to Delete Section 59(B) of the MHA 2001

[Guest guest]

If the deleted section 59b they would still claim it was an emergency & give ECT under common law .......i.e would claim acting in first response to patients best interests.

see -

Presentation on Proposal to Delete Section 59( of the MHA 2001Published February 24, 2010 Uncategorized Leave a Comment

Dr Pat Bracken

http://delete59b.wordpress.com/2010/02/24/presentation-on-proposal-to-delete-section-59b-of-the-mha-2001/

Consultant Psychiatrist and Clinical Director, West Cork Mental Health Service, Bantry, Co Cork

Pat.Bracken@...

I am a consultant psychiatrist and Clinical Director of the West Cork Mental Health Service. I have worked as a doctor in the field of mental health for nearly 27 years. I trained in psychiatry in Ireland and in the UK. I have worked as a psychiatrist for many years in difficult inner-city settings, in post-conflict situations in Africa and more laterally in a rural part of Ireland. I have publicly challenged my own profession to listen more attentively to the voices of patients and their carers, including those who are critical of psychiatry and I am known and (I hope) respected for promoting the active involvement of patients and carers in the development of services .

I am here today to explain why I believe that Section 59B of the Mental Health Act should be amended and, moreover, why I think that this should be the first step in an overhaul of the 2001 Mental Health Act which, in my opinion, puts far too much power in the hands of psychiatrists.

My essential argument is that Section 59B serves to safeguard the doctor who administers ECT, rather that the patient receiving it.

59( allows for ECT to be given to a non-consenting patient simply on the order of a consultant psychiatrist if that decision is supported by any colleague. Under the Act, the consultant is not obliged to consult with non-medical colleagues or the nearest relative, nor is he or she obliged to honour the patient's wishes if these are written in an advance directive. When treatment is given under the MHA, there is no legal comeback for a patient who subsequently feels they were harmed, or for a relative to intervene if they feel the treatment is wrong. In any other branch of medicine it would be unconscionable to allow a procedure to go ahead, except in the most dire emergency, without procuring consent, if not from the patient, then from a next-of-kin. If Section 59( was removed, ECT could still be given to patients without consent, but it would be given under common law . This is the situation pertaining in the rest of medicine when procedures are carried out on patients who cannot give consent. In this situation, the psychiatrist would have to proceed more carefully as he/she would not have the protection of the MHA 2001.

And let us be very clear what this procedure involves. It requires a general anaesthetic and then the passage of an electric current via electorodes attached to the head to the level that will induce a Grand Mal convulsion. It is the most invasive procedure currently used by general psychiatrists. It is now generally accepted that at least a third of recipients suffer substantial memory loss after the treatment . Some people lose large chunks – up to twenty years in some cases – of their remembered lives, including memories of their children's births, wedding days etc. The writer, Ernest Hemingway, famously blamed ECT for his suicide. In his suicide note he said that the treatment put him `out of business' by destroying his memory.

ECT is a treatment that is gradually disappearing world-wide. It is now used much less frequently across Europe, including the UK and Ireland. In Italy, it is effectively banned, in Germany and Belgium it can only be administered in special centres and in the UK the rules governing ECT without consent have been substantially tightened in the past decade . The WHO now argues that ECT should never be given without consent . I believe that more and more psychiatrists are becoming very wary about it's use. We are now nearly 10 years on from the date when the current MHA act was passed in Ireland, and the scientific evidence about the benefits and side-effects of ECT has moved on substantially.

As a psychiatrist, I maintain that we have to learn from the mistakes of the past, otherwise we are doomed to repeat them. In many ways, the history of psychiatry is not a happy read. In our enthusiasm to do things to the patients put into our care, we have inflicted terrible damage on many of them. Take, for example, the recipients of interventions such as lobotomy and insulin-coma treatment. For many years, these interventions were hailed as dramatically successful by doctors, families and even patients. For some they appeared as `life-saving'. Patients who were catatonic got up and talked and left hospital. If they had not been successful in some way or another they would not have been performed over such lengthy periods of time. At least 40,000 lobotomies were performed in the US, 17,000 in the UK. I don't know how many were performed in Ireland. In many cases it was only later that dreadful deficits were noticed and eventually lobotomy went out of fashion. Not all doctors recommended lobotomy, but some were enthusiasts and if you came under their care, there was a good chance that you would be given that intervention . The point is that psychiatrists differed greatly in the value they saw in the treatment and most importantly in how much they were open to see its negative effects.

I believe that this is the same with ECT.

There is a large variation in the use of ECT across the State, which suggests that some psychiatrists have much more faith in it than others. The Mental Health Commission figures for this variation of use in Ireland give substantial cause for concern . In 2008, out of 64 approved centres across the country, ECT was used in only 24 (37.5%). Even allowing for some movement of patients between hospitals specifically to receive this treatment, this is a remarkable variance. But if we look further, we find that only 2 programmes of ECT were delivered in the whole of County Cork (with a population of approx 480,000) while in Galway (with a population of approx 230,000, half that of Co Cork) 69 programmes were used. If my calculations are right, this means that, per head of population, ECT was used approximately 70 times more often in Galway than in Cork! This is an extraordinary degree of divergence.

What the figures on ECT demonstrate, I think, is that some Irish psychiatrists are `ECT enthusiasts'. The probability of these doctors seeing a patient (whether voluntary or involuntary) as being in need of ECT is going to be much greater than many of their colleagues. Furthermore, it is likely that they will be very aware of colleagues who also use ECT enthusiastically. In these circumstances, Section 59( offers no protection whatsoever for the patient. In fact, as I have already argued, the protection offered is in the other direction. This is no longer acceptable.

It brings to mind the enquiry into the practice of the obstetric services in Our Lady of Lourdes Hospital in Drogheda in recent times, where the discrepancy in the rates of Caesarean hysterectomy as compared with the rest of the country led eventually to the exposure of a scandalous situation for the women involved. Dr Neary performed 129 peripartum hysterectomies during his career over 25 years in this hospital. According to Judge Harding-e's report, the average consultant obstetrician can expect to carry out 4 of these procedures in his or her career, in extreme circumstances. The divergence of Dr Neary's practice from the average (an excess rate of approx 32 times) was deemed so problematic that he was eventually struck off the medical register. When it comes to ECT usage in Ireland we are talking about a divergence in medical practice that is twice this level.

I believe that we could be looking at a similar situation several more years down the line, when the already well-documented and damaging side-effects of ECT become more widely recognised.

Moreover, the recent television Prime Time investigation about the practice of symphysiotomy has added to public outrage about the way in which certain medical practices can be allowed to continue in the face of well-documented and serious side-effects. One of the most troubling aspects of these questionable obstetric practices, is that is has become clear that we cannot rely on medical colleagues to be the ones to investigate them.

In Ireland, we are struggling to get beyond the culture of medical paternalism that reigned in our health service until recently: the belief that doctors always know best and will act accordingly. The present government health strategy, A Vision for Change, aims to do just that. We need protections for patients that are substantially more transparent, more democratic, and more multi-disciplinary. The MHA 2001 puts enormous power and responsibility into the hands of consultant psychiatrists. It is now out of date.

-I believe that we need to do 4 things:

First, we need to move quickly to remove Section 59(. This will at least offer detained patients the protection of common law, something that the MHA 2001 currently denies them.

Secondly, we need to develop very clear guidelines for how decisions are made when patients cannot give consent.Thirdly, we need an external audit of ECT practice in Ireland. This audit should seek to examine the reasons behind the extraordinary level of variance in ECT use. It should also seek to explore, in some depth, the experiences of patients (both positive and negative) of this treatment. This review should not be led by a psychiatrist .

Fourth, we need to rethink our mental health legislation more generally. The current MHA, which essentially serves to endorse the culture of medical paternalism, needs to be replaced by a framework more in line with our mental health policy A Vision for Change.Pat Bracken MA MD MRCPsych DPM PhD

>> This is awful .Do people not have rights?> > > From: jeremy9282 jeremybryce1953@...> SSRI medications > Sent: Friday, July 15, 2011 12:23 PM> Subject: forced shock Ireland - Co Kildare> > >  > Family fight to stop shock therapy being forced on man, 40> By Hough> Thursday, July 14, 2011> A FAMILY are desperately seeking to stop the forced administration of electric shock therapy on a 40-year-old man who is being involuntarily detained at Lakeview mental health unit in Naas, Co Kildare> > Read more: http://www.irishexaminer.com/ireland/health/family-fight-to-stop-shock-therapy-being-forced-on-man-40-160963.html#ixzz1SCgDE32Y>  > Pritchard's family have said he is set to be given the controversial electroconvulsive therapy (ECT) against his will and are seeking to have it stopped. > > ECT electrically induces seizures in anaesthetised patients. > > Speaking to the Irish Examiner, 's sister Duffin said her brother has told his consultant psychiatrist at Lakeview that he does not want ECT: "He has also told his solicitor, his father, his mother, and his peer advocate at the hospital â€" and furthermore has signed a letter saying he does not want it. > > "We as a family are united and completely against this procedure. Words cannot describe the terrible effect on not only the patient but on their family, and the terrible damage which can be done," she said.> > Consultant psychiatrist Dr Pat Bracken, who campaigns against forced ECT, said he had advised Ms Duffin to send a message to the head of mental services of the HSE, Junior Health Minister Kathleen Lynch, and the Mental Health Commission, to highlight the situation. > > He said it was a "classic case" of the unfairness of the section of the Mental Health Act (MHA) which governs ECT. > > Section 59b of the act says if someone is "unwilling or unable" to consent they can be given the treatment on the opinion of two consultant psychiatrists. > > Dr Bracken is part of a campaign to delete this section of the act, therefore stopping forced ECT. > > "It puts all the power and responsibility into the hands of the doctors," he said. > > Former head of the Mental Health Commission, Hugh Kane, who is also part of the Delete 59b campaign, said it was unbelievable that the wishes of a patient and a family were not adhered to.>  > This appeared in the printed version of the Irish Examiner Thursday, July 14, 2011> > Read more: http://www.irishexaminer.com/ireland/health/family-fight-to-stop-shock-therapy-being-forced-on-man-40-160963.html#ixzz1SCg6wRw8>

[Guest guest]

If the deleted section 59b they would still claim it was an emergency & give ECT under common law .......i.e would claim acting in first response to patients best interests.

see -

Presentation on Proposal to Delete Section 59( of the MHA 2001Published February 24, 2010 Uncategorized Leave a Comment

Dr Pat Bracken

http://delete59b.wordpress.com/2010/02/24/presentation-on-proposal-to-delete-section-59b-of-the-mha-2001/

Consultant Psychiatrist and Clinical Director, West Cork Mental Health Service, Bantry, Co Cork

Pat.Bracken@...

I am a consultant psychiatrist and Clinical Director of the West Cork Mental Health Service. I have worked as a doctor in the field of mental health for nearly 27 years. I trained in psychiatry in Ireland and in the UK. I have worked as a psychiatrist for many years in difficult inner-city settings, in post-conflict situations in Africa and more laterally in a rural part of Ireland. I have publicly challenged my own profession to listen more attentively to the voices of patients and their carers, including those who are critical of psychiatry and I am known and (I hope) respected for promoting the active involvement of patients and carers in the development of services .

I am here today to explain why I believe that Section 59B of the Mental Health Act should be amended and, moreover, why I think that this should be the first step in an overhaul of the 2001 Mental Health Act which, in my opinion, puts far too much power in the hands of psychiatrists.

My essential argument is that Section 59B serves to safeguard the doctor who administers ECT, rather that the patient receiving it.

59( allows for ECT to be given to a non-consenting patient simply on the order of a consultant psychiatrist if that decision is supported by any colleague. Under the Act, the consultant is not obliged to consult with non-medical colleagues or the nearest relative, nor is he or she obliged to honour the patient's wishes if these are written in an advance directive. When treatment is given under the MHA, there is no legal comeback for a patient who subsequently feels they were harmed, or for a relative to intervene if they feel the treatment is wrong. In any other branch of medicine it would be unconscionable to allow a procedure to go ahead, except in the most dire emergency, without procuring consent, if not from the patient, then from a next-of-kin. If Section 59( was removed, ECT could still be given to patients without consent, but it would be given under common law . This is the situation pertaining in the rest of medicine when procedures are carried out on patients who cannot give consent. In this situation, the psychiatrist would have to proceed more carefully as he/she would not have the protection of the MHA 2001.

And let us be very clear what this procedure involves. It requires a general anaesthetic and then the passage of an electric current via electorodes attached to the head to the level that will induce a Grand Mal convulsion. It is the most invasive procedure currently used by general psychiatrists. It is now generally accepted that at least a third of recipients suffer substantial memory loss after the treatment . Some people lose large chunks – up to twenty years in some cases – of their remembered lives, including memories of their children's births, wedding days etc. The writer, Ernest Hemingway, famously blamed ECT for his suicide. In his suicide note he said that the treatment put him `out of business' by destroying his memory.

ECT is a treatment that is gradually disappearing world-wide. It is now used much less frequently across Europe, including the UK and Ireland. In Italy, it is effectively banned, in Germany and Belgium it can only be administered in special centres and in the UK the rules governing ECT without consent have been substantially tightened in the past decade . The WHO now argues that ECT should never be given without consent . I believe that more and more psychiatrists are becoming very wary about it's use. We are now nearly 10 years on from the date when the current MHA act was passed in Ireland, and the scientific evidence about the benefits and side-effects of ECT has moved on substantially.

As a psychiatrist, I maintain that we have to learn from the mistakes of the past, otherwise we are doomed to repeat them. In many ways, the history of psychiatry is not a happy read. In our enthusiasm to do things to the patients put into our care, we have inflicted terrible damage on many of them. Take, for example, the recipients of interventions such as lobotomy and insulin-coma treatment. For many years, these interventions were hailed as dramatically successful by doctors, families and even patients. For some they appeared as `life-saving'. Patients who were catatonic got up and talked and left hospital. If they had not been successful in some way or another they would not have been performed over such lengthy periods of time. At least 40,000 lobotomies were performed in the US, 17,000 in the UK. I don't know how many were performed in Ireland. In many cases it was only later that dreadful deficits were noticed and eventually lobotomy went out of fashion. Not all doctors recommended lobotomy, but some were enthusiasts and if you came under their care, there was a good chance that you would be given that intervention . The point is that psychiatrists differed greatly in the value they saw in the treatment and most importantly in how much they were open to see its negative effects.

I believe that this is the same with ECT.

There is a large variation in the use of ECT across the State, which suggests that some psychiatrists have much more faith in it than others. The Mental Health Commission figures for this variation of use in Ireland give substantial cause for concern . In 2008, out of 64 approved centres across the country, ECT was used in only 24 (37.5%). Even allowing for some movement of patients between hospitals specifically to receive this treatment, this is a remarkable variance. But if we look further, we find that only 2 programmes of ECT were delivered in the whole of County Cork (with a population of approx 480,000) while in Galway (with a population of approx 230,000, half that of Co Cork) 69 programmes were used. If my calculations are right, this means that, per head of population, ECT was used approximately 70 times more often in Galway than in Cork! This is an extraordinary degree of divergence.

What the figures on ECT demonstrate, I think, is that some Irish psychiatrists are `ECT enthusiasts'. The probability of these doctors seeing a patient (whether voluntary or involuntary) as being in need of ECT is going to be much greater than many of their colleagues. Furthermore, it is likely that they will be very aware of colleagues who also use ECT enthusiastically. In these circumstances, Section 59( offers no protection whatsoever for the patient. In fact, as I have already argued, the protection offered is in the other direction. This is no longer acceptable.

It brings to mind the enquiry into the practice of the obstetric services in Our Lady of Lourdes Hospital in Drogheda in recent times, where the discrepancy in the rates of Caesarean hysterectomy as compared with the rest of the country led eventually to the exposure of a scandalous situation for the women involved. Dr Neary performed 129 peripartum hysterectomies during his career over 25 years in this hospital. According to Judge Harding-e's report, the average consultant obstetrician can expect to carry out 4 of these procedures in his or her career, in extreme circumstances. The divergence of Dr Neary's practice from the average (an excess rate of approx 32 times) was deemed so problematic that he was eventually struck off the medical register. When it comes to ECT usage in Ireland we are talking about a divergence in medical practice that is twice this level.

I believe that we could be looking at a similar situation several more years down the line, when the already well-documented and damaging side-effects of ECT become more widely recognised.

Moreover, the recent television Prime Time investigation about the practice of symphysiotomy has added to public outrage about the way in which certain medical practices can be allowed to continue in the face of well-documented and serious side-effects. One of the most troubling aspects of these questionable obstetric practices, is that is has become clear that we cannot rely on medical colleagues to be the ones to investigate them.

In Ireland, we are struggling to get beyond the culture of medical paternalism that reigned in our health service until recently: the belief that doctors always know best and will act accordingly. The present government health strategy, A Vision for Change, aims to do just that. We need protections for patients that are substantially more transparent, more democratic, and more multi-disciplinary. The MHA 2001 puts enormous power and responsibility into the hands of consultant psychiatrists. It is now out of date.

-I believe that we need to do 4 things:

First, we need to move quickly to remove Section 59(. This will at least offer detained patients the protection of common law, something that the MHA 2001 currently denies them.

Secondly, we need to develop very clear guidelines for how decisions are made when patients cannot give consent.Thirdly, we need an external audit of ECT practice in Ireland. This audit should seek to examine the reasons behind the extraordinary level of variance in ECT use. It should also seek to explore, in some depth, the experiences of patients (both positive and negative) of this treatment. This review should not be led by a psychiatrist .

Fourth, we need to rethink our mental health legislation more generally. The current MHA, which essentially serves to endorse the culture of medical paternalism, needs to be replaced by a framework more in line with our mental health policy A Vision for Change.Pat Bracken MA MD MRCPsych DPM PhD

>> This is awful .Do people not have rights?> > > From: jeremy9282 jeremybryce1953@...> SSRI medications > Sent: Friday, July 15, 2011 12:23 PM> Subject: forced shock Ireland - Co Kildare> > >  > Family fight to stop shock therapy being forced on man, 40> By Hough> Thursday, July 14, 2011> A FAMILY are desperately seeking to stop the forced administration of electric shock therapy on a 40-year-old man who is being involuntarily detained at Lakeview mental health unit in Naas, Co Kildare> > Read more: http://www.irishexaminer.com/ireland/health/family-fight-to-stop-shock-therapy-being-forced-on-man-40-160963.html#ixzz1SCgDE32Y>  > Pritchard's family have said he is set to be given the controversial electroconvulsive therapy (ECT) against his will and are seeking to have it stopped. > > ECT electrically induces seizures in anaesthetised patients. > > Speaking to the Irish Examiner, 's sister Duffin said her brother has told his consultant psychiatrist at Lakeview that he does not want ECT: "He has also told his solicitor, his father, his mother, and his peer advocate at the hospital â€" and furthermore has signed a letter saying he does not want it. > > "We as a family are united and completely against this procedure. Words cannot describe the terrible effect on not only the patient but on their family, and the terrible damage which can be done," she said.> > Consultant psychiatrist Dr Pat Bracken, who campaigns against forced ECT, said he had advised Ms Duffin to send a message to the head of mental services of the HSE, Junior Health Minister Kathleen Lynch, and the Mental Health Commission, to highlight the situation. > > He said it was a "classic case" of the unfairness of the section of the Mental Health Act (MHA) which governs ECT. > > Section 59b of the act says if someone is "unwilling or unable" to consent they can be given the treatment on the opinion of two consultant psychiatrists. > > Dr Bracken is part of a campaign to delete this section of the act, therefore stopping forced ECT. > > "It puts all the power and responsibility into the hands of the doctors," he said. > > Former head of the Mental Health Commission, Hugh Kane, who is also part of the Delete 59b campaign, said it was unbelievable that the wishes of a patient and a family were not adhered to.>  > This appeared in the printed version of the Irish Examiner Thursday, July 14, 2011> > Read more: http://www.irishexaminer.com/ireland/health/family-fight-to-stop-shock-therapy-being-forced-on-man-40-160963.html#ixzz1SCg6wRw8>

[Guest guest]

If the deleted section 59b they would still claim it was an emergency & give ECT under common law .......i.e would claim acting in first response to patients best interests.

see -

Presentation on Proposal to Delete Section 59( of the MHA 2001Published February 24, 2010 Uncategorized Leave a Comment

Dr Pat Bracken

http://delete59b.wordpress.com/2010/02/24/presentation-on-proposal-to-delete-section-59b-of-the-mha-2001/

Consultant Psychiatrist and Clinical Director, West Cork Mental Health Service, Bantry, Co Cork

Pat.Bracken@...

I am a consultant psychiatrist and Clinical Director of the West Cork Mental Health Service. I have worked as a doctor in the field of mental health for nearly 27 years. I trained in psychiatry in Ireland and in the UK. I have worked as a psychiatrist for many years in difficult inner-city settings, in post-conflict situations in Africa and more laterally in a rural part of Ireland. I have publicly challenged my own profession to listen more attentively to the voices of patients and their carers, including those who are critical of psychiatry and I am known and (I hope) respected for promoting the active involvement of patients and carers in the development of services .

I am here today to explain why I believe that Section 59B of the Mental Health Act should be amended and, moreover, why I think that this should be the first step in an overhaul of the 2001 Mental Health Act which, in my opinion, puts far too much power in the hands of psychiatrists.

My essential argument is that Section 59B serves to safeguard the doctor who administers ECT, rather that the patient receiving it.

59( allows for ECT to be given to a non-consenting patient simply on the order of a consultant psychiatrist if that decision is supported by any colleague. Under the Act, the consultant is not obliged to consult with non-medical colleagues or the nearest relative, nor is he or she obliged to honour the patient's wishes if these are written in an advance directive. When treatment is given under the MHA, there is no legal comeback for a patient who subsequently feels they were harmed, or for a relative to intervene if they feel the treatment is wrong. In any other branch of medicine it would be unconscionable to allow a procedure to go ahead, except in the most dire emergency, without procuring consent, if not from the patient, then from a next-of-kin. If Section 59( was removed, ECT could still be given to patients without consent, but it would be given under common law . This is the situation pertaining in the rest of medicine when procedures are carried out on patients who cannot give consent. In this situation, the psychiatrist would have to proceed more carefully as he/she would not have the protection of the MHA 2001.

And let us be very clear what this procedure involves. It requires a general anaesthetic and then the passage of an electric current via electorodes attached to the head to the level that will induce a Grand Mal convulsion. It is the most invasive procedure currently used by general psychiatrists. It is now generally accepted that at least a third of recipients suffer substantial memory loss after the treatment . Some people lose large chunks – up to twenty years in some cases – of their remembered lives, including memories of their children's births, wedding days etc. The writer, Ernest Hemingway, famously blamed ECT for his suicide. In his suicide note he said that the treatment put him `out of business' by destroying his memory.

ECT is a treatment that is gradually disappearing world-wide. It is now used much less frequently across Europe, including the UK and Ireland. In Italy, it is effectively banned, in Germany and Belgium it can only be administered in special centres and in the UK the rules governing ECT without consent have been substantially tightened in the past decade . The WHO now argues that ECT should never be given without consent . I believe that more and more psychiatrists are becoming very wary about it's use. We are now nearly 10 years on from the date when the current MHA act was passed in Ireland, and the scientific evidence about the benefits and side-effects of ECT has moved on substantially.

As a psychiatrist, I maintain that we have to learn from the mistakes of the past, otherwise we are doomed to repeat them. In many ways, the history of psychiatry is not a happy read. In our enthusiasm to do things to the patients put into our care, we have inflicted terrible damage on many of them. Take, for example, the recipients of interventions such as lobotomy and insulin-coma treatment. For many years, these interventions were hailed as dramatically successful by doctors, families and even patients. For some they appeared as `life-saving'. Patients who were catatonic got up and talked and left hospital. If they had not been successful in some way or another they would not have been performed over such lengthy periods of time. At least 40,000 lobotomies were performed in the US, 17,000 in the UK. I don't know how many were performed in Ireland. In many cases it was only later that dreadful deficits were noticed and eventually lobotomy went out of fashion. Not all doctors recommended lobotomy, but some were enthusiasts and if you came under their care, there was a good chance that you would be given that intervention . The point is that psychiatrists differed greatly in the value they saw in the treatment and most importantly in how much they were open to see its negative effects.

I believe that this is the same with ECT.

There is a large variation in the use of ECT across the State, which suggests that some psychiatrists have much more faith in it than others. The Mental Health Commission figures for this variation of use in Ireland give substantial cause for concern . In 2008, out of 64 approved centres across the country, ECT was used in only 24 (37.5%). Even allowing for some movement of patients between hospitals specifically to receive this treatment, this is a remarkable variance. But if we look further, we find that only 2 programmes of ECT were delivered in the whole of County Cork (with a population of approx 480,000) while in Galway (with a population of approx 230,000, half that of Co Cork) 69 programmes were used. If my calculations are right, this means that, per head of population, ECT was used approximately 70 times more often in Galway than in Cork! This is an extraordinary degree of divergence.

What the figures on ECT demonstrate, I think, is that some Irish psychiatrists are `ECT enthusiasts'. The probability of these doctors seeing a patient (whether voluntary or involuntary) as being in need of ECT is going to be much greater than many of their colleagues. Furthermore, it is likely that they will be very aware of colleagues who also use ECT enthusiastically. In these circumstances, Section 59( offers no protection whatsoever for the patient. In fact, as I have already argued, the protection offered is in the other direction. This is no longer acceptable.

It brings to mind the enquiry into the practice of the obstetric services in Our Lady of Lourdes Hospital in Drogheda in recent times, where the discrepancy in the rates of Caesarean hysterectomy as compared with the rest of the country led eventually to the exposure of a scandalous situation for the women involved. Dr Neary performed 129 peripartum hysterectomies during his career over 25 years in this hospital. According to Judge Harding-e's report, the average consultant obstetrician can expect to carry out 4 of these procedures in his or her career, in extreme circumstances. The divergence of Dr Neary's practice from the average (an excess rate of approx 32 times) was deemed so problematic that he was eventually struck off the medical register. When it comes to ECT usage in Ireland we are talking about a divergence in medical practice that is twice this level.

I believe that we could be looking at a similar situation several more years down the line, when the already well-documented and damaging side-effects of ECT become more widely recognised.

Moreover, the recent television Prime Time investigation about the practice of symphysiotomy has added to public outrage about the way in which certain medical practices can be allowed to continue in the face of well-documented and serious side-effects. One of the most troubling aspects of these questionable obstetric practices, is that is has become clear that we cannot rely on medical colleagues to be the ones to investigate them.

In Ireland, we are struggling to get beyond the culture of medical paternalism that reigned in our health service until recently: the belief that doctors always know best and will act accordingly. The present government health strategy, A Vision for Change, aims to do just that. We need protections for patients that are substantially more transparent, more democratic, and more multi-disciplinary. The MHA 2001 puts enormous power and responsibility into the hands of consultant psychiatrists. It is now out of date.

-I believe that we need to do 4 things:

First, we need to move quickly to remove Section 59(. This will at least offer detained patients the protection of common law, something that the MHA 2001 currently denies them.

Secondly, we need to develop very clear guidelines for how decisions are made when patients cannot give consent.Thirdly, we need an external audit of ECT practice in Ireland. This audit should seek to examine the reasons behind the extraordinary level of variance in ECT use. It should also seek to explore, in some depth, the experiences of patients (both positive and negative) of this treatment. This review should not be led by a psychiatrist .

Fourth, we need to rethink our mental health legislation more generally. The current MHA, which essentially serves to endorse the culture of medical paternalism, needs to be replaced by a framework more in line with our mental health policy A Vision for Change.Pat Bracken MA MD MRCPsych DPM PhD

>> This is awful .Do people not have rights?> > > From: jeremy9282 jeremybryce1953@...> SSRI medications > Sent: Friday, July 15, 2011 12:23 PM> Subject: forced shock Ireland - Co Kildare> > >  > Family fight to stop shock therapy being forced on man, 40> By Hough> Thursday, July 14, 2011> A FAMILY are desperately seeking to stop the forced administration of electric shock therapy on a 40-year-old man who is being involuntarily detained at Lakeview mental health unit in Naas, Co Kildare> > Read more: http://www.irishexaminer.com/ireland/health/family-fight-to-stop-shock-therapy-being-forced-on-man-40-160963.html#ixzz1SCgDE32Y>  > Pritchard's family have said he is set to be given the controversial electroconvulsive therapy (ECT) against his will and are seeking to have it stopped. > > ECT electrically induces seizures in anaesthetised patients. > > Speaking to the Irish Examiner, 's sister Duffin said her brother has told his consultant psychiatrist at Lakeview that he does not want ECT: "He has also told his solicitor, his father, his mother, and his peer advocate at the hospital â€" and furthermore has signed a letter saying he does not want it. > > "We as a family are united and completely against this procedure. Words cannot describe the terrible effect on not only the patient but on their family, and the terrible damage which can be done," she said.> > Consultant psychiatrist Dr Pat Bracken, who campaigns against forced ECT, said he had advised Ms Duffin to send a message to the head of mental services of the HSE, Junior Health Minister Kathleen Lynch, and the Mental Health Commission, to highlight the situation. > > He said it was a "classic case" of the unfairness of the section of the Mental Health Act (MHA) which governs ECT. > > Section 59b of the act says if someone is "unwilling or unable" to consent they can be given the treatment on the opinion of two consultant psychiatrists. > > Dr Bracken is part of a campaign to delete this section of the act, therefore stopping forced ECT. > > "It puts all the power and responsibility into the hands of the doctors," he said. > > Former head of the Mental Health Commission, Hugh Kane, who is also part of the Delete 59b campaign, said it was unbelievable that the wishes of a patient and a family were not adhered to.>  > This appeared in the printed version of the Irish Examiner Thursday, July 14, 2011> > Read more: http://www.irishexaminer.com/ireland/health/family-fight-to-stop-shock-therapy-being-forced-on-man-40-160963.html#ixzz1SCg6wRw8>

[Guest guest]

If the deleted section 59b they would still claim it was an emergency & give ECT under common law .......i.e would claim acting in first response to patients best interests.

see -

Presentation on Proposal to Delete Section 59( of the MHA 2001Published February 24, 2010 Uncategorized Leave a Comment

Dr Pat Bracken

http://delete59b.wordpress.com/2010/02/24/presentation-on-proposal-to-delete-section-59b-of-the-mha-2001/

Consultant Psychiatrist and Clinical Director, West Cork Mental Health Service, Bantry, Co Cork

Pat.Bracken@...

I am a consultant psychiatrist and Clinical Director of the West Cork Mental Health Service. I have worked as a doctor in the field of mental health for nearly 27 years. I trained in psychiatry in Ireland and in the UK. I have worked as a psychiatrist for many years in difficult inner-city settings, in post-conflict situations in Africa and more laterally in a rural part of Ireland. I have publicly challenged my own profession to listen more attentively to the voices of patients and their carers, including those who are critical of psychiatry and I am known and (I hope) respected for promoting the active involvement of patients and carers in the development of services .

I am here today to explain why I believe that Section 59B of the Mental Health Act should be amended and, moreover, why I think that this should be the first step in an overhaul of the 2001 Mental Health Act which, in my opinion, puts far too much power in the hands of psychiatrists.

My essential argument is that Section 59B serves to safeguard the doctor who administers ECT, rather that the patient receiving it.

59( allows for ECT to be given to a non-consenting patient simply on the order of a consultant psychiatrist if that decision is supported by any colleague. Under the Act, the consultant is not obliged to consult with non-medical colleagues or the nearest relative, nor is he or she obliged to honour the patient's wishes if these are written in an advance directive. When treatment is given under the MHA, there is no legal comeback for a patient who subsequently feels they were harmed, or for a relative to intervene if they feel the treatment is wrong. In any other branch of medicine it would be unconscionable to allow a procedure to go ahead, except in the most dire emergency, without procuring consent, if not from the patient, then from a next-of-kin. If Section 59( was removed, ECT could still be given to patients without consent, but it would be given under common law . This is the situation pertaining in the rest of medicine when procedures are carried out on patients who cannot give consent. In this situation, the psychiatrist would have to proceed more carefully as he/she would not have the protection of the MHA 2001.

And let us be very clear what this procedure involves. It requires a general anaesthetic and then the passage of an electric current via electorodes attached to the head to the level that will induce a Grand Mal convulsion. It is the most invasive procedure currently used by general psychiatrists. It is now generally accepted that at least a third of recipients suffer substantial memory loss after the treatment . Some people lose large chunks – up to twenty years in some cases – of their remembered lives, including memories of their children's births, wedding days etc. The writer, Ernest Hemingway, famously blamed ECT for his suicide. In his suicide note he said that the treatment put him `out of business' by destroying his memory.

ECT is a treatment that is gradually disappearing world-wide. It is now used much less frequently across Europe, including the UK and Ireland. In Italy, it is effectively banned, in Germany and Belgium it can only be administered in special centres and in the UK the rules governing ECT without consent have been substantially tightened in the past decade . The WHO now argues that ECT should never be given without consent . I believe that more and more psychiatrists are becoming very wary about it's use. We are now nearly 10 years on from the date when the current MHA act was passed in Ireland, and the scientific evidence about the benefits and side-effects of ECT has moved on substantially.

As a psychiatrist, I maintain that we have to learn from the mistakes of the past, otherwise we are doomed to repeat them. In many ways, the history of psychiatry is not a happy read. In our enthusiasm to do things to the patients put into our care, we have inflicted terrible damage on many of them. Take, for example, the recipients of interventions such as lobotomy and insulin-coma treatment. For many years, these interventions were hailed as dramatically successful by doctors, families and even patients. For some they appeared as `life-saving'. Patients who were catatonic got up and talked and left hospital. If they had not been successful in some way or another they would not have been performed over such lengthy periods of time. At least 40,000 lobotomies were performed in the US, 17,000 in the UK. I don't know how many were performed in Ireland. In many cases it was only later that dreadful deficits were noticed and eventually lobotomy went out of fashion. Not all doctors recommended lobotomy, but some were enthusiasts and if you came under their care, there was a good chance that you would be given that intervention . The point is that psychiatrists differed greatly in the value they saw in the treatment and most importantly in how much they were open to see its negative effects.

I believe that this is the same with ECT.

There is a large variation in the use of ECT across the State, which suggests that some psychiatrists have much more faith in it than others. The Mental Health Commission figures for this variation of use in Ireland give substantial cause for concern . In 2008, out of 64 approved centres across the country, ECT was used in only 24 (37.5%). Even allowing for some movement of patients between hospitals specifically to receive this treatment, this is a remarkable variance. But if we look further, we find that only 2 programmes of ECT were delivered in the whole of County Cork (with a population of approx 480,000) while in Galway (with a population of approx 230,000, half that of Co Cork) 69 programmes were used. If my calculations are right, this means that, per head of population, ECT was used approximately 70 times more often in Galway than in Cork! This is an extraordinary degree of divergence.

What the figures on ECT demonstrate, I think, is that some Irish psychiatrists are `ECT enthusiasts'. The probability of these doctors seeing a patient (whether voluntary or involuntary) as being in need of ECT is going to be much greater than many of their colleagues. Furthermore, it is likely that they will be very aware of colleagues who also use ECT enthusiastically. In these circumstances, Section 59( offers no protection whatsoever for the patient. In fact, as I have already argued, the protection offered is in the other direction. This is no longer acceptable.

It brings to mind the enquiry into the practice of the obstetric services in Our Lady of Lourdes Hospital in Drogheda in recent times, where the discrepancy in the rates of Caesarean hysterectomy as compared with the rest of the country led eventually to the exposure of a scandalous situation for the women involved. Dr Neary performed 129 peripartum hysterectomies during his career over 25 years in this hospital. According to Judge Harding-e's report, the average consultant obstetrician can expect to carry out 4 of these procedures in his or her career, in extreme circumstances. The divergence of Dr Neary's practice from the average (an excess rate of approx 32 times) was deemed so problematic that he was eventually struck off the medical register. When it comes to ECT usage in Ireland we are talking about a divergence in medical practice that is twice this level.

I believe that we could be looking at a similar situation several more years down the line, when the already well-documented and damaging side-effects of ECT become more widely recognised.

Moreover, the recent television Prime Time investigation about the practice of symphysiotomy has added to public outrage about the way in which certain medical practices can be allowed to continue in the face of well-documented and serious side-effects. One of the most troubling aspects of these questionable obstetric practices, is that is has become clear that we cannot rely on medical colleagues to be the ones to investigate them.

In Ireland, we are struggling to get beyond the culture of medical paternalism that reigned in our health service until recently: the belief that doctors always know best and will act accordingly. The present government health strategy, A Vision for Change, aims to do just that. We need protections for patients that are substantially more transparent, more democratic, and more multi-disciplinary. The MHA 2001 puts enormous power and responsibility into the hands of consultant psychiatrists. It is now out of date.

-I believe that we need to do 4 things:

First, we need to move quickly to remove Section 59(. This will at least offer detained patients the protection of common law, something that the MHA 2001 currently denies them.

Secondly, we need to develop very clear guidelines for how decisions are made when patients cannot give consent.Thirdly, we need an external audit of ECT practice in Ireland. This audit should seek to examine the reasons behind the extraordinary level of variance in ECT use. It should also seek to explore, in some depth, the experiences of patients (both positive and negative) of this treatment. This review should not be led by a psychiatrist .

Fourth, we need to rethink our mental health legislation more generally. The current MHA, which essentially serves to endorse the culture of medical paternalism, needs to be replaced by a framework more in line with our mental health policy A Vision for Change.Pat Bracken MA MD MRCPsych DPM PhD

>> This is awful .Do people not have rights?> > > From: jeremy9282 jeremybryce1953@...> SSRI medications > Sent: Friday, July 15, 2011 12:23 PM> Subject: forced shock Ireland - Co Kildare> > >  > Family fight to stop shock therapy being forced on man, 40> By Hough> Thursday, July 14, 2011> A FAMILY are desperately seeking to stop the forced administration of electric shock therapy on a 40-year-old man who is being involuntarily detained at Lakeview mental health unit in Naas, Co Kildare> > Read more: http://www.irishexaminer.com/ireland/health/family-fight-to-stop-shock-therapy-being-forced-on-man-40-160963.html#ixzz1SCgDE32Y>  > Pritchard's family have said he is set to be given the controversial electroconvulsive therapy (ECT) against his will and are seeking to have it stopped. > > ECT electrically induces seizures in anaesthetised patients. > > Speaking to the Irish Examiner, 's sister Duffin said her brother has told his consultant psychiatrist at Lakeview that he does not want ECT: "He has also told his solicitor, his father, his mother, and his peer advocate at the hospital â€" and furthermore has signed a letter saying he does not want it. > > "We as a family are united and completely against this procedure. Words cannot describe the terrible effect on not only the patient but on their family, and the terrible damage which can be done," she said.> > Consultant psychiatrist Dr Pat Bracken, who campaigns against forced ECT, said he had advised Ms Duffin to send a message to the head of mental services of the HSE, Junior Health Minister Kathleen Lynch, and the Mental Health Commission, to highlight the situation. > > He said it was a "classic case" of the unfairness of the section of the Mental Health Act (MHA) which governs ECT. > > Section 59b of the act says if someone is "unwilling or unable" to consent they can be given the treatment on the opinion of two consultant psychiatrists. > > Dr Bracken is part of a campaign to delete this section of the act, therefore stopping forced ECT. > > "It puts all the power and responsibility into the hands of the doctors," he said. > > Former head of the Mental Health Commission, Hugh Kane, who is also part of the Delete 59b campaign, said it was unbelievable that the wishes of a patient and a family were not adhered to.>  > This appeared in the printed version of the Irish Examiner Thursday, July 14, 2011> > Read more: http://www.irishexaminer.com/ireland/health/family-fight-to-stop-shock-therapy-being-forced-on-man-40-160963.html#ixzz1SCg6wRw8>