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Two thirds of patients can't get life-saving ECT treatment for mental illness during the pandemic

Jul 15, 2020, 23:01 PM by RCPsych Press Office
New research from the Royal College of Psychiatrists shows that two thirds of people (66%) who would be having electroconvulsive therapy (ECT) can’t access the life-saving treatment because of COVID-19.

New research from the Royal College of Psychiatrists shows that two thirds of people (66%) who would be having electroconvulsive therapy (ECT) can’t access the life-saving treatment because of COVID-19.

Survey data reveals that 437 out of an estimated total of 600 patients across the UK can’t access the vital therapy used for some types of severe mental illness that have not responded to other treatments. A third of those (33%) have seen their condition worsen, a further 18% have been admitted to hospital and 7% have been detained.

ECT is most commonly used for depression. Most people (46%) are referred for life-threatening depression when a rapid response is required. Patients (39%) also get referred for depression that has not responded to drug, psychological or other treatments.

In 2018-2019, around 68% of patients were “much-improved” or “very much improved” − 1,361 courses out of a total of 2,004. Some saw no change in their condition and 1% felt worse.

In the past four months, 69 of 89 clinics across the UK that took part in the survey report that they are forced to ration services because of the pandemic, mainly because the required infection control procedures have reduced treatment capacity but also due to lack of staff and PPE when it was not available.

Dr Angela McGilloway from the Royal College of Psychiatrists, said:

“As the health system had to cope with COVID, services had to be reduced or suspended, which meant some of our very seriously ill patients have not been able to get the ECT treatment they desperately need. As a result, many have become more ill and required prolonged hospital admissions.
“Even though the health service has been quite quick to adapt in these unprecedented circumstances, we need to make sure services resume urgently so that patients can access this life-saving treatment again."

ECT is given as a course of treatments twice a week, typically for 3-8 weeks. During each treatment an anaesthetic and muscle relaxant are given. The anaesthetic means that patients are asleep throughout the procedure, when an electric current is passed across the head. The muscle relaxant reduces the movement of the controlled fit which typically lasts less than 90 seconds.

As with any treatment, it can have side effects. Up to 40% of patients can have temporary memory problems while having ECT. For example, they may forget conversations with visitors during this time.

About 2% of people report severe memory problems directly after ECT. This tends to affect memories of events that occurred during, or shortly before, the depression started. Sometimes these memories return fully or partially, but sometimes these gaps can be permanent.

The treatment should be adjusted if people experience side effects during the course.

Sam’s experience of ECT

70-year-old Sam from Cardiff has had ECT to treat her severe depression. She first had ECT back in the 1970’s after a psychotic episode following childbirth. She had another course when she became depressed about 10 years ago and had been well since.

In December last year Sam became particularly unwell. After some months, her consultant, Professor George Kirov, recommended a maintenance course of ECT. She was admitted to hospital in March but only managed to have three treatments (17/24/31 March) before her treatment had to be stopped because of COVID.

“I felt so frightened when the treatments stopped because I just didn’t know how I was going to get better without it” said Sam. “I have been close to suicide in the past and I fell into utter despair, without my treatment, I honestly hoped that I would get COVID and die.”

Sam’s ECT clinic wasn’t able to start her treatment again until the 7th of May. Since then she’s been having them weekly. She’s now been discharged from hospital.

“ECT has saved my life a number of times” said Sam. “There are side effects, I get some short-term memory loss, but for me, that’s far outweighed by the benefits.”

The Royal College of Psychiatrists has updated the patient information for anyone who is considering whether to have electroconvulsive therapy (ECT) – and their families or friends.

More information regarding ECTAS data is available.

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