The Code of Practice for the 2003 Act

There is a Code of Practice for the 2003 Act. Chapter 10 contains guidance on treatment given under Part 16 of the Act:

Safeguards for ECT and other treatments regulated under Section 237

“Any DMP [Dr David Rooke in my case] is required to take into account the principles of the Act and in particular the views of the patient…”

Dr Rooke did not take into account the views of the patient (me) because he never met me or spoke to me and Dr Hannah Badial also failed to tell me anything about the treatment and never discussed it with me.

NICE Guidelines on Depression

The NICE Guidelines on Depression apply in Scotland, and references to the 2003 Act can be substituted for references to English legislation. They are too lengthy to quote in full, but the overriding principle set out at the beginning is that ‘People have the right to be involved in discussions and make informed decisions about their care’. They include the following:

1.13.1 Consider electroconvulsive therapy (ECT) for the treatment of severe depression if:

the person chooses ECT in preference to other treatments based on their past experience of ECT and what has previously worked for them or a rapid response is needed (for example, if the depression is life-threatening because the person is not eating or drinking) or other treatments have been unsuccessful (see the recommendations on further-line treatment). [2022]

I didn't choose ECT and didn't want it. My depression wasn't life-threatening: I was on a ward eating regularly by the time that it was administered. Other treatments hadn't been unsuccessful: I was getting better, had never had any mental illness or treatment before and had been taking drugs for just over three weeks when ECT started.

The British Psychological Society Report

The British Psychological Society published a report in October 2020 titled ‘Understanding Depression.’ In Part 3 they give a psychological view on electro-convulsive therapy. They state that:

’NICE guidelines recommend ECT only in cases where an adult is very severely depressed and thought to be at grave risk of imminent death through suicide or self-neglect, and where psychological therapy has already been tried as well as several different drugs.’

‘We agree with the relevant NICE guidelines, that ECT should never be used without informed consent.’

Clearly the guidance provided by the British Psychological Society was also ignored by the doctors at the Royal Cornhill Hospital. Is this professional misconduct?

The Royal Cornhill Hospital Patient Leaflet

A web search after I left hospital and started to find out about ECT revealed that Nicholas Webb made a Freedom of Information request to Grampian Health Board in March 2020 and they sent him copies of the consent forms and ECT leaflet that are supposedly used at the Royal Cornhill Hospital. Until then I didn't know that they existed. The patient leaflet states:

'Before your first treatment, the anaesthetist will usually visit you in the ward and you will have the opportunity to ask any questions.'

This didn't happen!

'An ECT or clinic nurse will also visit you on the ward before your first treatment to talk through what happens. If you do have any questions please ask any member of the team. It can be helpful to write down any questions you may have.'

This didn't happen!

'You might have some memory problems during your ECT course. This usually returns to normal after 6-8 weeks. This is monitored before and after your course of ECT.'

They used the Montreal Cognitive Assessment, which is a laughably simple test that Donald Trump famously passed. My notes record that I was too distressed to do the test on at least one occasion. There was no longer-term follow-up and no proper test of memory impairment, so the doctors who inflicted ECT on me have no idea whether they caused any long-term damage to my brain.

The Mental Welfare Commission for Scotland Guide

The Mental Welfare Commission for Scotland has produced a Good Practice Guide: Consent to Treatment: A Guide for Mental Health Practitioners. Chapter 5 covers treatment without consent and gives some general considerations:

Treatment in the absence of consent can be a distressing experience. Whichever piece of legislation is being used, principles should guide best practice. If a person is being treated in the absence of consent, this does not remove the duties of the practitioner to:

Give the person as much information as possible about the treatment in a way the person can understand; Take the person’s views into account.

If these are duties, does it mean that it is professional negligence to not tell the patient anything about the treatment or seek his views? It seems to me that Dr Jane Murdoch, Dr David Rooke and particularly Dr Hannah Badial were negligent.

UN and WHO Joint Guidance on Mental Health, Human Rights and Legislation 2023

The Guidance states that:

"If permitted, ECT must only be administered with the written or documented, free and informed consent of the person concerned. International human rights standards clarify that ECT without consent violates the right to physical and mental integrity and may constitute torture and ill-treatment. People being offered ECT should be made aware of all its risks and potential short- and long-term harmful effects, such as memory loss and brain damage."

So the Guidance confirms that what they did to me in the Royal Cornhill Hospital was torture and ill-treatment!