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Electroconvulsive Treatment (ECT)

Compulsory detention or treatment

Most mental health treatments that people receive in hospital happen on a voluntary basis. People usually agree to be in the hospital and have consented to their treatment. However, when people are very ill (e.g. there are serious concerns about their safety, or the safety of others) they can be held in hospital and given compulsory treatment there, whether or not they agree to it. In 2014/15 figure by the Care Quality Commission shows that 51% of mental health inpatients were held under a section of the Mental Health Act (sometimes called being “sectioned”). This page is about the people who spoke to us about their own experiences of compulsory detention and/or treatments.

People can be detained under a section of the Mental Health Act 1983 to allow medical staff to examine, assess and treat them. Even people who are voluntarily in hospital can later be detained there for further treatment without their consent if they are sectioned under the Mental Health Act. Medical professionals must usually consult with a range of professionals and a person’s nearest relative before sectioning a person, but that relative cannot always prevent their loved one being sectioned although they can challenge it at a Mental Health Tribunal. The Mental Health Act sets out when it is legal to detain and treat someone, who is authorised to do it, and what procedures should be followed. The Mental Health Act is a complex legal framework that varies between specific countries in the UK.

People are sectioned for a certain length of time, and can be ‘de-sectioned’. An assessment about whether to section someone is made based on their condition at that time. For example although Jenny wasn’t sectioned the first time she was admitted to hospital (a time when she had ECT), she was sectioned on subsequent admissions.

Being sectioned
At the time when they were being considered for “sectioning”, some people knew what was happening around them, but others were too unwell to really understand. In these circumstances it was sometimes family members who most clearly remembered what the sectioning involved. Yvonne was asked if she wanted to go to the hospital for a weekend’s assessment and thought it would be somewhere to rest, like a spa. She was sectioned at the end of the weekend, and says her “brain had just completely shut down” because it couldn’t cope with how she was feeling.
 

Catherine Z was having hallucinations and doesn’t have much recollection of being forced into an ambulance and pinned down. Her notes say she was violent and so ill she couldn’t be assessed.

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Catherine Z was having hallucinations and doesn’t have much recollection of being forced into an ambulance and pinned down. Her notes say she was violent and so ill she couldn’t be assessed.

Age at interview: 52
Sex: Female
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And one of my hallucinations was that I opened my bedroom curtains and there was a whole wedding party on the lawn and, for those who don’t understand hallucinations, the people were really, really, really there and I could hear them and I could see them, and it was really happening. And it all came to a head where I wasn't feeding my son, I’d stopped feeding him because he didn’t need feeding because we were, we sort of transcended to another state of consciousness, you know? 

So with that my family obviously needed to get me into hospital. The GP came round and a social worker came round and they basically forced me into an ambulance and I went to hospital. So when I got to hospital, I was given extremely high doses of drugs. I was in bed nurses sitting on me pinning me down in the bed and I don’t have any recollection of this but apparently I was quite violent, I was hitting and screaming and totally uncontrollable. Having subsequently seen my notes, it seems that I was so ill I couldn’t be assessed. They couldn’t actually speak to me or assess me. 

It said on my notes that I was staring, I don’t think I was staring into space, I think I was watching what was happening in my head I had the usual sort of preoccupations that you get when you’re extremely manic, well I was psychotic by then.
 

Suzanne explains that when she was in hospital under a Section, she was too unwell to understand what was happening. She only realised she’d been sectioned when she was de-sectioned.

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Suzanne explains that when she was in hospital under a Section, she was too unwell to understand what was happening. She only realised she’d been sectioned when she was de-sectioned.

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John Y: Well you didn’t have any… you didn’t participate in any of the discussion for ECT because you weren’t well enough.

Suzanne: No I didn’t.

John Y: You were like…

Suzanne: I was like floridly psychotic, not psychotic but catatonic. I was…

John Y: Yes, but what’s the description, the Mental Health Act?

Suzanne: I didn’t have capacity.

John Y: No. Legally…

Suzanne: Yes.

John Y: They decided that you weren’t able to …

Suzanne: Yes.

John Y: …make a decision.

Suzanne: Yes, I didn’t have capacity to make the decision so …

John Y: So what do they call that?

I mean there are various different sections of the Mental Health Act.

John Y: Yes, sectioned.

Suzanne: Yes.

John Y: So that… so you’d been sectioned by that stage. 

Suzanne: Yes, I was under the care of the doctors.

John Y: Yes, so you couldn’t make any legal…

Suzanne: I was under is it Section III of the Mental Health Act?

John Y: Legally you couldn’t make any decision yourself.

Suzanne: Yes, well that doesn’t mean that you …

John Y: So even if you had said…

Suzanne: It doesn’t mean that …

John Y: … no I don’t want it. You wouldn’t, they…

Suzanne: Yes, well but that doesn’t mean that the doctors won’t tell you what’s going to happen even if you’re sectioned. They would do. It’s just that I didn’t have the capacity to take in that information.

John Y: And it also means that you don’t have any power to change your course of treatment.

Suzanne: I think I was sectioned meant that I was under the care of the doctors but yeah, I was under their treatment and I had to stay in hospital, but I can remember being de-sectioned and I can remember that meeting very well with the doctors. Yes. And they said, “We’re now releasing you from the Mental Health Act…” or whatever. “You are no longer sectioned.” And it was like news to me, I’ve been sectioned. 

John Y: Oh well you wouldn’t have known.

Suzanne: No I didn’t know anything. I didn’t even know if I was wearing like, I was going to say if I was wearing clothes or not, but like I was kind of like a total zombie.
Most remembered going to see a doctor and being admitted to hospital where an assessment was made. Many were relieved that there was some help available for their problems.
 

After Carys’s daughter was diagnosed with schizophrenia twenty years ago she was sectioned several times. On one occasion several police cars came to collect her.

After Carys’s daughter was diagnosed with schizophrenia twenty years ago she was sectioned several times. On one occasion several police cars came to collect her.

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I don’t know how many times she was sectioned. I’ve lost count of how many times she was sectioned. She was sectioned for stupid things. For example, one dreadful night, during the course of the day her social worker had been to see her and she told her didn’t want to see her. And she made the mistake of actually touching her arm. And that night, and it was a most filthy, awful day in November, and it was dark and I had six policemen in my house, two police cars with the lights going outside. A doctor, psychiatrist, social worker, all taking this tiny little girl away. 

She said to the policeman, she was crying, and I was crying. She said, “I’ve got to go to the toilet.” So he said, we were all downstairs, so he said to her, “Go on then.” And he followed her up the stairs. So I thought I don’t think so, so I followed her up the stairs as well. And he said, “Leave the door open.” This is a 19 year old young woman. And she said, “I’m not going then.” So I said, “Don’t be so stupid.” To this policeman. I said, “Shut the door, [name of daughter].” Anyway she opened the door two minutes later and she said, “Mum”. And I said, “What’s the matter?” She said, “I’ve started my period.” So I said, “Okay.” So I went into her bedroom, got what she needed etc. and handed it through.

By this time there were two policemen at the top of the stairs and I said, “What do you think you’re doing?” I said, “Go downstairs, go downstairs and wait. I will bring my daughter down, when she’s better, when she’s sorted.” So they started, “Oh I don’t know, we will do” I said, “If you don’t go downstairs, I’ll throw you down, please yourself.” 

So they went downstairs and I said to [name of daughter], “Shut the door, lock it, do whatever you need to do. Nobody will disturb you. I will stay on the stairs until you’re okay.” She was still crying obviously. And I went downstairs and I said, “This is enough.” I said, “I want you all out now, every single policeman in this house. Out. And I want one of those cars gone.” And they took her to the unit in a police car 
Some people told us they were given the option of going into hospital voluntarily. Jane and Kathleen spoke about going in to hospital a few years ago on a voluntarily basis when they knew that being “sectioned” was a possibility. Others who had been to hospital on a voluntary basis a long time ago recalled feeling threatened with a section if they tried to leave. Over twenty years ago when Tracy was a nurse she was admitted to the psychiatry department in the same group of hospitals she worked in. She wasn’t sectioned but she recalled being told that if she left the ward they would section her, even though this would not have been lawful.
 

David Y’s wife was a voluntary patient who was threatened with a “section” in the early 1990s if she left the ward. He now knows this should not have happened.

David Y’s wife was a voluntary patient who was threatened with a “section” in the early 1990s if she left the ward. He now knows this should not have happened.

Age at interview: 52
Sex: Male
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And did you know anything at all about, you know, mental health law or your rights in the hospital or those sorts of things?

No and there was none, there was none available at the time, you can go into hospital now and there’s, you can get the information and I’ve learnt about the mental health act of ’83 and 2007 [inaudible speech] and health, my rights about being on a section and how a nurses holding powers and things like that, oh I’ve learnt all that.

And was [name of wife] ever held in a section?

Oh she was threatened, she was threatened that if she ever left the wards she would be brought back and put under section which they shouldn’t have done in the first place, they could even then, when she was being treated, they couldn’t say that that’s what they would do to her, yes a nurse has holding powers but the nurse could hold her there and the doctor could review that and have his holding power but you shouldn’t tell people if you leave I’m going to have you brought back on section.
ECT and Compulsory treatment
ECT is not usually given without consent. Even if someone is detained in hospital under a section of the Mental Health Act, they can still refuse ECT most of the time. However, ECT can be given without consent in serious circumstances. This can happen for example if it is an emergency e.g. it could be life saving, or if a doctor assesses that a person is not able to make a decision for themselves. If a doctor judges that someone is too ill to make a decision about whether to have ECT, another doctor or “SOAD” – Second Opinion Appointed Doctor – also needs to agree that ECT is necessary. 

While many of the people we spoke to had not experienced ECT as a compulsory treatment, many people felt under some pressure to agree to ECT, or were unsure whether they could be made to undergo ECT if they refused it (see ‘Deciding whether to have ECT’). Some felt if they refused ECT they might be sectioned and given the treatment without their consent. When Beattie had ECT in 1975 she said they sort of “nagged” her and she eventually agreed. When Albert had ECT in 1960, he describes being made to sign a form to consent otherwise he would be given the treatment under section. While practices have changed over time, people could still feel under pressure to agree.
 

Matt said although his wife seemed to think they could force her to have ECT a few years ago, that wasn’t his impression. But ultimately she was very ill and she reluctantly agreed.

Matt said although his wife seemed to think they could force her to have ECT a few years ago, that wasn’t his impression. But ultimately she was very ill and she reluctantly agreed.

Age at interview: 36
Sex: Male
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And a part of that they were worried about her safety, but part of it was that they wanted to start a treatment of ECT and although my understanding is it’s not essential to be an inpatient to go through ECT, I think it helps and I think… I think, you know, if somebody’s particularly ill or, not completely on board with the idea it helps. So that was why they wanted her to be there, and once she’d been there for only two or three days and was kind of settled down a bit they started talking to her, to the two of us about it. And she was very reluctant as I’d expected, but also, partly because of the way in which she was ill she was very kind of resigned as well, and I think, I don’t think this was ever said to her. I don’t think it was the case, but she, she… took what they were saying to mean, if you didn’t agree with the ECT that they would do it somehow compulsorily, somehow under a section. Which I mean I don’t know, but it wasn’t my understanding that they could do that. But that was what she thought. So she agreed to do it fairly reluctantly. But also I think in a kind of you know, just to an extent she didn’t really care, because of just how very depressed she was.
 

Tania was in a private hospital when a doctor first recommended she should have ECT twenty years ago. Although she was a voluntary patient she signed because she thought she would be sectioned if she didn’t agree.

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Tania was in a private hospital when a doctor first recommended she should have ECT twenty years ago. Although she was a voluntary patient she signed because she thought she would be sectioned if she didn’t agree.

Age at interview: 41
Sex: Female
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I’d escaped from hospital and almost killed myself, and he really, you know, he was very threatening about the whole thing and I was very ill at that point, and quite paranoid, and I just, you know, I didn’t know what he was talking about. I mean he said, you know, “ECT.” 

And he was like, “you’re going to have it, you know, if you don’t sign the form.” I remember him holding out the form, and saying you know, “This is the form…” And I’m like, “But I don’t want to have the treatment. Why would I sign the form?” And he was like, “Well, you know, what you’re going to sign it, or you will have it signed for you, and if you have it signed for you, you will be sectioned, and if you’re sectioned that will be it. You know, you’ll never be able to… You know, it will go on your passport, you’re never going to be able to go and visit your brother in America anymore. You won’t be able to…” You know, these were kind of things and so it just, [laughs] I was really scared about the whole thing. 
Many of those who had been given ECT without their consent didn’t like undergoing compulsory treatment or detention (one patient talked of doctors “slapping different sections on [them]”). They felt that they had lost control over what was happening to them.
 

Sue had been abused as a child and felt giving her ECT without her consent was wrong. To her, the ECT procedure compounded her childhood experience.

Sue had been abused as a child and felt giving her ECT without her consent was wrong. To her, the ECT procedure compounded her childhood experience.

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And I think the other thing which I sort of tried to emphasise is there was no consideration about why I’d ended up in the mental health system. You know, initially the reason why, you know, these things had happened, is this control thing about being manipulated, about being a force to sort of respond to my abuser, being sort of groomed, mentally scarred and I don’t think anyone at the time took that background into response of the whole procedure of ECT and it was like, to me, I’ve used the word ‘abuse’ it like another, but a mental abuse. I mean you have that anyway with the physical and mental abuse of the childhood but it’s compounded by having, going through that whole procedure. 

And it’s very difficult. I find it very difficult to move on from anything like that because it’s formed me as a person. I think because I was very young when it happened, it’s so embedded on my psyche, it’s like branded, and when you brand someone, that’s it, then it’s very difficult to actually, I think even with surgery, you’re always left with some kind of scar. 

Oh no, it didn’t. That wasn’t the cause, that wasn’t the cause. It was just an effect that should have been linked to my past and was that actually suitable treatment for me? When you think about the physical part of it, it would very relate to what I’d been put through as a child, having been held down, whether is psychologically or physically, and being put in a position where by losing consciousness, I was having this treatment, and how would I respond and what were people doing to me…
Some felt unhappy when family members consented (through power of attorney) to ECT for them or were consulted, and agreed to ECT, when they didn’t want to have it. When her husband agreed to her having ECT, Sue felt the decision was taken out of her control and blamed him: “…at the time, I felt like even the closest thing [in] my life, my husband, has put me in this position”. Resentment could be particularly strong if family members were distant.
 

Yvonne didn’t want ECT and kept running away from hospital. Her estranged mother gave consent for her to have it, but Yvonne felt she shouldn’t have had a say.

Yvonne didn’t want ECT and kept running away from hospital. Her estranged mother gave consent for her to have it, but Yvonne felt she shouldn’t have had a say.

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I kept running away from the hospital, because now I just knew that this treatment sounded horrific and I didn’t have, I did na want anything to do with it. 

So then eventually they got a Court Order to say that they could give me treatment. My Mum had to sign papers to say that we could, that I could receive the treatment as well. Which I didn’t like because the relationship had broken down with my Mum, so in my eyes she shouldn’t have had any say in what my treatment was, or wasn’t going to be. Which was why I’m really glad now that named persons are available, because if I had, if I had to go through that again, it would have been a family that I was staying with at the time that would have made the decision for me, because they were people at the time that I trusted. And for a long time I felt that ECT was something that my Mum did to me, because we were nae getting on.
Relatives were not always consulted as to whether someone had ECT. Especially where people had had ECT a long time ago, some carers spoke to us about wanting to have a say, but finding their opinion was treated as unimportant. Twenty years ago, Carys could do nothing about her adult daughter receiving ECT, even when she thought it was an ineffective treatment for her.

Advance statements 
In hindsight some people accepted it had been necessary for them to have ECT, although they had been too distressed and unwell to consent at the time. Yvonne said twenty years on she realised ECT probably saved her life (see for more “Messages to others’). As ECT is one of the only effective treatments available for when she is severely unwell, Suzanne has now written an ‘advance statement’ stating that if she is very unwell in the future, she should have ECT.
 

Tania now has an “advance statement”. She feels reassured that ECT can be carried out involuntarily when she is very unwell.

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Tania now has an “advance statement”. She feels reassured that ECT can be carried out involuntarily when she is very unwell.

Age at interview: 41
Sex: Female
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I will say, in later life, now knowing that ECT is the one thing that actually can work for me when I’m ill and also knowing that when I’m ill I do become paranoid and I will often get to the point where actually I don’t want to have treatment and I don’t want to be in hospital and I don’t want anyone to be looking after me. I’ve actually now written an advanced statement, which I signed last time I was in hospital to say that, you know, actually, you know, by signing this, no matter how well I seem, even if I say that I don’t want to carry on with the treatment, even if I argue that I don’t want to, you know, I accept that I want this to be done on me and if it has to be compulsorily, you know, even if I have to have a repeat of the same thing, I don’t mind. 

I’ve actually kind of, I’ve almost sort of pretty much authorised that with an advanced statement, you know, which actually kind of came into play last time, because it did get to the point when I was in hospital when I was so ill that I suddenly became quite paranoid and I didn’t want to have the treatment and with my ability to act like there’s nothing going on, I probably, you know, I would have been able to convince a Mental Health Tribunal that it wasn’t necessary for me to have the treatment. But because I’d signed this piece of paper, you know, I knew actually that there was no choice. I mean I kind of asked my doctor and he said, “Yes, you know, what I will show them the piece of paper.” So, and it worked, and in the end I said, “Yes, I’ll have it.” And I agreed, because I knew there was no choice. I knew if I didn’t agree, I was going to end up having it any way. And its, you know, that is better to kind of walk into the room willingly rather than be dragged in, but I do know that in my future, I may well get ill again at some point, and if I do, you know, I may well need it, need the treatment and I might decide that I don’t want the treatment, that it’s not the right thing and you know, it may happen that I do have literally, as happened to me before, be kind of you know, held down and it sort of, until I’m under the anaesthetic and I actually accept that.

And I’m pleased that, bizarrely people, I don’t think anyone who has never been in this position could understand it, but I’m pleased for my own sake and I’m mainly pleased for the sake of my family that the law has those powers to do that. I’m pleased that there is an element in the Mental Health Act that allows ECT to be carried out on people involuntarily, because I think actually for me, my life probably depends on that law being there, and I think if they eradicated that law, it would actually be a breach of my human rights, rather than the law itself being a breach, you know, if the law was eradicated. 
For others, ECT was not a procedure they wanted to have again and they have written an advanced statement to that effect. Yet some said they were concerned that ECT might be given to them in the future regardless of their wishes.
 

Sue feels being sectioned “strips you really of any power”. She’s asked not to have ECT in future but feels her wishes will be “railroaded”.

Sue feels being sectioned “strips you really of any power”. She’s asked not to have ECT in future but feels her wishes will be “railroaded”.

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It’s not necessarily a fear of hospitals, is it? It’s a fear of being in a situation where I have no control. And I think as human beings we need to feel we have some sort of control over our destiny and what we’re going through. Okay sometimes you can’t, or it’s very difficult to make decisions for yourself and be able to follow through with them. But in a situation like that, where you sectioned under the Mental Health Act, it sort of strips you really of any power.

I mean when you think about it, psychiatrists in some ways have more power than the legal system. Because at least you can go to court and sort of present your case, but with the section. Though really if a psychiatrist has recommended it, then it’s very rare that you don’t get sectioned, and because you’re required to stay you can’t really put your point of view across. And it was all these past experiences and experience at the time, and subsequent sort of like reaction to it that’s just led to a mess, and I still feel there’s a mess now. And there’s ultimate fear that it will happen again because they’ve not, it still goes ahead. Even though I’ve asked and it’s on my well-being plan not to do it, and I just re-iterate there’s other things in the well-being plan that are just railroaded. So will they rail road that.
If you are clear you do not wish to receive ECT even if your life is in danger and you have already made a valid and applicable advance decision refusing ECT, or your attorney under a Lasting Power of Attorney, or a court-appointed deputy, or a Court has refused ECT on your behalf, then the ECT should not be given to you (MIND June 2016)

Last reviewed January 2018.
Last updated January 2018.
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