The Florida chapter of the international mental health watchdog, Citizens Commission on Human Rights (CCHR), applauds a recent Supreme Court decision in Victoria, Australia that ruled the forcible use of electroshock treatment (ECT) violates patients’ human rights.

The case involved two patients who refused ECT, one who she said she was concerned about ECT causing her memory loss—a well-known debilitating effect of the procedure that sends up to 460 volts of electricity through the brain. A state psychiatric agency overrode the patients’ decisions and claimed the woman lacked the capacity to “carefully consider” ECT’s “advantages” and “disadvantages.” The Supreme Court judge, Justice Kevin Bell, said the agency had failed to respect the two patients’ human rights. “A person does not lack the capacity to give informed consent simply by making a decision that others consider to be unwise according to their individual values and situation,” he stated. [1]

Diane Stein, president of CCHR Florida said that while the decision reinforces that electroshock given without consent is a human rights violation—a step in the right direction—the entire practice of ECT is a human rights violation and should be banned. She said the Victorian decision highlighted the issue of informed consent rights, but charges that a U.S. review of ECT information provided to patients likely violates these rights and could constitute consumer fraud.

ECT Consumer Fraud Investigation Needed

CCHR’s international headquarters recently conducted an analysis of how ECT is promoted to consumers either on mental health facility websites or in their ECT consent forms. As an advocacy group for mental health consumers, CCHR wants to ensure patients are informed without deception or misrepresentation.

A sample of 33 psychiatric facilities in 24 states, including five from Florida—two owned by for-profit companies, Universal Health Services (UHS) and Hospital Corp of America (HCA)—were reviewed for their promotion of ECT. Only one facility in Maine cited a reference in “support” of its claims; only two facilities informed patients that ECT couldn’t cure. Jan Eastgate, international president of CCHR, said, “Psychiatrists admit they have no idea how ECT works, which is not made clear in online ECT promotion or consent forms. There are about 100 theories but no facts. We found the claimed theories differed from one facility to the next, making informed consent impossible.”

The theories documented from the analysis ranged from the grand mal seizure that ECT causes “may help the brain ‘rewire’ itself, which helps relieve symptoms,” “electrical stimulation of nerve cells within the brain [releases] chemicals that may help restore normal functioning,” and the electrical current causes “changes in brain chemistry that can rapidly reverse symptoms of certain mental illnesses.” “There’s not a shred of scientific evidence to support this,” Eastgate said. “The misinformation given in order to extract a patient’s consent should be investigated for violating informed consent rights and consumer fraud.”

UHS has 16 behavioral healthcare facilities in Florida, 2 of which deliver ECT. River Point Behavioral Health in Jacksonville performs 900-1000 ECT treatments a year and claims that electroshock is safe for pregnant women. However, CCHR says that missing from online promotion is that pregnant women receiving ECT can experience adverse events that include miscarriage, premature labor, stillbirth, fetal heart problems and malformations. [2]

The adverse effects of ECT that include memory loss, cognitive impairment and brain damage, can prolong the length of a hospital stay, according to a journal study. ECT, therefore, can increase hospital profits and may be an incentive for administering it, Stein says. [3]

She said that Florida saw a 60% increase between 2015 and 2016 in the number of Medicaid recipients who were electroshocked. [4] The youngest receiving ECT covered by Medicaid were aged 16-17, while the age group most likely to be shocked were aged 51-60, followed by those aged 31 and 50. She said CCHR Florida is supporting a Florida and nation-wide ban on ECT. More than 50,000 people have already signed the online petition. Click here to sign.

Sources:
[1] “Orders for forced ‘shock therapy’ breached human rights of schizophrenia patients, court rules,” The Guardian, 1 Nov. 2018, https://www.theguardian.com/society/2018/nov/01/shock-therapy-court-upholds-appeal-by-patients-prescribed-ect-against-their-will;
“Orders for forced ‘shock therapy’ breached human rights of schizophrenia patients, court rules,”ABC News, 1 Nov. 2018,
https://www.abc.net.au/news/2018-11-01/human-rights-must-be-upheld-forced-shock-ect-therapy-court-rules/10454750
[2] Kari Ann Leiknes, et al. “Electroconvulsive therapy during pregnancy: a systematic review of case studies,” Arch Womens Ment Health, epub 24 Nov 2013.
[3] Draper B, Luscombe G., “Quantification of factors contributing to length of stay in an acute psychogeriatric ward,” International Journal of Geriatric Psychiatry, 1998; 13:1–7.
[4] “Electroconvulsive Therapy (ECT) Provider Recipient and Payment Information, July1, 2015 – June 30, 2016,” Florida Agency for Health Care Administration, Obtained through Freedom of Information Act Request, 2016.