Some children as young as 14 years old in Western Australia can now give consent to receive electroconvulsive therapy (ECT) — electric shock treatment, in which seizures are induced in a patient via electrodes placed on their head — for psychiatric illnesses under a new law.
The Western Australian government is arguing that its new Mental Health Bill will give patients more say in their treatment. Kim Hames, Western Australia’s Health Minister, describes the new bill as “a progressive and effective tool to, first and foremost, promote and protect the rights of the persons with severe mental illness, in addition to, importantly, promoting access to mental health treatment, care and support.”
In contrast, Michelle Scott, the Commissioner for Children and Young People, says that ECT should be simply banned for treating children and that 16 should be the minimal age to receive it.
Should a teenager, and one who has severe mental illness, be the one to decide about undergoing a treatment as serious as ECT? Should the decision instead be made by a parent or other adult?
Is Electric Shock Treatment Safe?
The 1975 movie One Flew Over the Cuckoo’s Nest, in which doctors and the infamous “Nurse Ratched” used ECT punitively to control patients, still shapes popular perceptions about it. ECT is safer now, psychiatrists emphasize, and (according to one doctor) helps 80 percent of patients.
Psychiatrists are still uncertain about how ECT works and concerns certainly persist about how safe the procedure is. Two years ago, an attempt by the American Psychiatric Association to have electroshock devices reclassified from a high-risk to a medium-risk category — meaning that they would have been in the same category as syringes and surgical drills — ended with the FDA ruling that the devices are too risky for such a change.
ECT has been connected to memory loss and brain damage; headaches, nausea and agitation are other side effects. Opponents to the use of ECT (including some who have undergone the treatment) say that the short-term effects it provides are not worth it.
ECT is Often a Treatment of Last Resort — But Should It Be?
Overall, mental health experts in Australia — and elsewhere — remain divided about the benefits of ECT and not only for teenagers. ECT is often considered a therapy of last resort for adults with schizophrenia, severe depression, bipolar disorder and other serious mental illnesses who have not responded to other treatments.
My mother-in-law was considered to be in such a situation when she underwent electroshock therapy after falling into a psychotic depression. She had had serious depression and anxiety for much of her life and been hospitalized at various times. She had taken a number of psychiatric medications for many years but these were no longer as effective as she grew older and had more and more physical ailments.
She was catatonic and hallucinating when doctors recommended electroshock treatment; family members made the decision to try it. In my mother-in-law’s case, ECT did seem to help. She became interested in reading the newspaper, watching CNN and calling out the answers to Jeopardy questions, rather than lying in bed for days and not responding to others; she was discharged from the psychiatric hospital. As she grew older, most of the family ceased trying to treat her mental illness and this returned.
ECT in Children Under 14: Should It Be Banned?
Professionals from the Mayo Clinic in Minnesota (which is one of the few places in the U.S. that uses ECT to treat children and adolescents) recently reported that, while not a cure, ECT is a “safe, reasonably well-tolerated, and effective treatment, especially for the most severely ill patients who have shown resistance to both pharmacotherapy and psychotherapy.” According to the report, some patients who were treated with ECT had made at least one suicide attempt, been hospitalized for periods of time and were not able to attend school.
Dr. Judy Hyde, the president of the Australian Clinical Psychology Association, also notes that ECT can be effective but that the side effects cannot be discounted. While she has had patients who “would not be alive today had they not undergone this treatment,” one patient now “has serious memory problems as a result of the treatment,” she tells Australia’s ABC.net.
It is important to make sure that as many treatment options are available and especially for those with severe mental illness. But as Hyde underscores, ”a 14 year-old who is depressed, suicidal, is not in a position to be able to make a decision that is objective.”