Dear Minister,
Re: Section 59(B) of the Mental Health Act 2001
We hope this finds you well.
We are writing to enquire about developments in relation to the above.
When Senator Dan Boyle proposed the deletion of Section 59(B) in the Senate last year, there was an agreement that the heads of a bill to do this would be brought before the Dail by the summer session. Senator Boyle, in the company of John McCarthy, agreed to postpone debate in the Senate on the day. As we understand it, the amendment to delete 59(b) was to stand alone as a proposal in the Dail, as it was worded in the Senate amendment.
We would respectfully ask if there are plans to progress this matter.
At the hearing in Leinster House, the College of Psychiatry’s position was that there should be minimal amendments to the current regulations governing the use of ECT in Irish hospitals. Their proposal was that 1) the word ‘unwilling’ should be removed, 2) that the second opinion consultant should be nominated from a panel held by the Mental Health Commission (MHC) and that this consultant should ‘consult’ with another member of the Multi Disciplinary Team (MDT), 3) that the College itself should, in conjunction with the MHC, collect information about the use of ECT.
We believe that these changes are far from what is needed and what is being demanded by many service users in Ireland. In reality, they will lead to no significant change in the status quo. Doctors will still be able to order ECT for patients without their consent and with minimal consultation with anyone else. There will be no redress for those who feel that they were treated wrongly. The safeguards for patients will continue to be inadequate. We believe that many people working in mental health share these concerns.
We acknowledge that many patients feel that they have benefited from ECT. This is not disputed. However, a very large number do not benefit and many are significantly harmed by the procedure. When you organized the two presentations to parliamentarians earlier this year, you indicated that you thought there was merit in both sides of the debate. We hope that you will not now renege on this by putting forward the College’s proposal as your answer to the debate. To do this would be to turn away from the many service users, relatives and professionals who have grave concerns about ECT and particularly its use with patients who cannot give consent.
Our proposal to delete Section 59(B) will not affect the provision of ECT on a voluntary basis. However, we believe that the regulations governing voluntary ECT need to be amended as there is evidence that up to 50% of people who have this treatment do not feel that it was properly explained to them. It is questionable how ‘voluntary’ their consent is in these circumstances.
What is really at stake in this debate is an effort to open up the field of mental health so that different voices can be heard. For too long, the voice of the medical profession has dominated. Only service users who agreed with the medical model and who presented no real challenge to the status quo were heard. Times have changed. This culture of medical paternalism is no longer acceptable and is completely out of keeping with the values of A Vision for Change (VfC). This makes the case that: ‘service users and carers should be involved in a meaningful way with the planning and delivery of care. A partnership approach should be taken to the planning, development, delivery, evaluation and monitoring of mental health services, with the inclusion of all stakeholders. It is through partnership that trust is built for all involved’ (VfC, p 15). Many service users in Ireland and internationally do not experience the medical framing of their problems as helpful. In fact, many feel that they have been harmed by the overly forceful use of the medical approach. Some feel that they have been abused. We believe that such individuals, and the groups that represent them, have a right to be ‘stakeholders’ in the partnership approach advocated by VfC. To exclude them, to ignore them when they challenge the current power structures in the mental health field would be a travesty and an insult to those who worked to produce VfC.
However, we believe that if the voices of ‘critical’ service users are to be heard and given the same respect afforded to those who are happy with the traditional medical approach, the powers invested in mental health professionals, especially psychiatrists, will have to be lessened.
ECT is a controversial intervention. In their presentation at Leinster House, the College of Psychiatry presented a very positive version of the empirical evidence about the efficacy, safety and mode of action of this treatment. The obvious enthusiasm for ECT displayed by those who presented is out of keeping with the practice of most psychiatrists in Britain and Ireland over the past 20 years. ECT is being used less and less across these islands. Most psychiatrists seem increasingly slow to prescribe this treatment. However, the wide variation in usage of ECT across the state demonstrates that while the majority of psychiatrists are using this treatment less often, there are a minority who are ‘ECT enthusiasts’. This fact, particularly when combined with the catchment area system of mental health care (in which service users have no control over which psychiatrist will be involved in their care) is a very strong argument against the status quo.
At present, Ireland is undergoing a major cultural change. Deference to traditional sources of authority has been substantially eroded by scandals involving the clergy, politicians, bankers, financiers and the medical profession. We believe that it is time to seriously interrogate the power structures involved in the mental health system. This system, which has been dominated by the psychiatric profession since its origins in the asylums of the 19th century, has failed many of the people who were placed in its care. This debate about ECT has drawn public attention to the fact that massive powers continue to be placed in the hands of psychiatrists. Our argument is not anti-psychiatry. But we do seek a psychiatry that is more humble and more willing (and able) to engage respectfully with those who critique the medical model.
We urge you not to endorse the proposal presented by the College of Psychiatry. We urge you to consider removing Section 59(B) of the Mental Health Act, thereby placing ECT alongside all the other treatments that can be prescribed by doctors, and giving psychiatric patients the right to legal redress when they feel they have been treated badly.
Yours etc,
Pat Bracken
Harry Gijbels
John McCarthy
Paddy McGowan
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