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Information, consent and perceived coercion: patients’ perspectives on electroconvulsive therapy

Coordinator, Service User Research Enterprise

Til H. Wykes, BSc, PhD, DClin Psych

Professor of Psychology

Jonathan P. Bindman, BA, MA, BM BCh

Clinical Senior Lecturer

Pete S. Fleischmann, BA MA

Researcher, Service User Research Enterprise, Institute of Psychiatry, London UK

Correspondence: Dr Diana Rose, Service User Research Enterprise, PO 34, Health Services Research Department, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. Tel: 0207 848 5066; e-mail: d.rose{at}iop.kcl.ac.uk

Declaration of interest Funding detailed in Acknowledgements. D.R. and P.F. have been recipients of ECT and J.B. has administered it.

Background Electroconvulsive therapy (ECT) is a procedure that attracts special safeguards under common law for voluntary patients and under both current and proposed mental health legislation, for those receiving compulsory treatment.

Aims To review patients’ views on issues of information, consent and perceived coercion.

Method Seventeen papers and reports were identified that dealt with patients’ views on information and consent in relation to ECT; 134 ‘testimonies’ or first-hand accounts were identified. The papers and reports were subjected to a descriptive systematic review. The testimony data were analysed qualitatively.

Results Approximately half the patients reported that they had received sufficient information about ECT and side-effects. Approximately a third did not feel they had freely consented to ECT even when they had signed a consent form. Clinician-led research evaluates these findings to mean that patients trust their doctors, whereas user-led work evaluates similar findings as showing inadequacies in informed consent.

Conclusion Neither current nor proposed safeguards for patients are sufficient to ensure informed consent with respect to ECT, at least in England and Wales.

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