A major international survey of people receiving electroconvulsive therapy (ECT) has found that most patients are not asked about the childhood adversities or recent life stressors that they believe caused their difficulties.
The survey findings, published in the International Journal of Mental Health Nursing, suggest that people are prescribed ECT, often against their will, without the underlying causes of their mental health problems being recognised and addressed by other therapeutic means.
The new survey, conducted by three ECT recipients and three psychologists - including lead author Professor John Read of the University of East London - gathered responses from 858 ECT recipients and 286 family members and friends across 44 countries. It is the largest study of its kind to date.
The findings show that 84% of ECT recipients reported childhood adversities, such as emotional neglect or physical and sexual abuse. Of those, 78% believed these experiences contributed to the problems for which ECT was prescribed. Yet only 32% said mental health services had asked about these adversities, and only 30% felt they had been "therapeutically addressed".
Recent stressors also went largely unrecognised. Some 81% of ECT recipients reported at least one significant stressor in the six months before treatment, most commonly loneliness or coercive/emotional abuse. 67% believed these stressors played a role in their difficulties, but only 34% were asked about them, and just 21% felt they had been addressed.
The researchers conclude:
"Mental health professionals should ensure that patients are asked about the life events and circumstances they believe contributed to the difficulties for which ECT is being considered and offered some help with them."
Professor John Read, Professor of Clinical Psychology at the University of East London, said:
"This is a disturbing example of what happens when you medicalise human distress. How can electricity possibly address child abuse, or domestic violence? These findings are a stark wake up call for a system urgently in need of a fundamental paradigm shift. The survey insights also align with United Nations and World Health Organization concerns that mental health systems are neglecting social determinants such as poverty, violence and discrimination.
"At the University of East London, we are determined to use our academic research to address these social inequalities. We hope these findings will encourage a radical rethink of mental health support, one that moves beyond diagnosis and invasive procedures to a more holistic, trauma-informed approach to addressing the social context of distress."
Co-author Sue Cunliffe, herself an ECT recipient, said:
"The hopelessness and entrapment caused by domestic abuse gave me just one option, suicide, to ease the pain. For that I was given ECT and ended up so brain damaged I had to give up my job as a doctor. In a recent report my GP wrote 'domestic abuse misdiagnosed and ECT given in error … causing brain damage'."
Co-author Sarah Hancock, also an ECT recipient, added:
"The results of our ECT patient survey highlight the absence of routine identification and treatment of the real causes of our symptoms. These results demonstrate I am far from the only person prematurely prescribed ECT without finding out what was really going on and what I really needed."
Rosie Weatherley, Information Content Manager from Mind, the UK's largest mental health NGO said, "Mind echoes concerns raised by this research - the evidence base for ECT has never been fit for purpose and this latest study further substantiates the need for a re-think about whether and when this treatment is offered to patients."
