Lives will be lost if psychiatrists can’t make the call

Lives will be lost if seriously ill psychiatric patients are allowed to refuse a controversial form of therapy, a well-known Clare psychiatrist has claimed.
Retired public consultant psychiatrist, Dr Moosajee Bhamjee insists that removing the option of prescribing electroconvulsive therapy (ECT) to involuntary patients with severe depression or other serious illnesses who lack capacity and are unable to consent to treatment will result in deaths.
“Will the minister take responsibility if a patient dies? Who takes responsibility if I say that a person needs ECT, the person says no, who is responsible if this person dies of starvation?
“That is what happens with severe forms of depression. Some seriously depressed or ill patients will not eat or take fluids. Who decides in these cases?” Dr Bhamjee asked.
Minister of State at the Department of Health, Kathleen Lynch told a recent mental health forum in Ennis that the Department was going to remove the provision allowing ECT for unwilling patients.
“If you can say, I don’t want that (ECT) to happen, then that will have to be taken on board. Then there are times when a person doesn’t have capacity. Then that is a different situation,” Minister Lynch added.
She explained the department was also going to deal with the voluntary and involuntary admission of patients to make it harder for voluntary patients to become involuntary ones.
“It is about making changes in a legal setting as to how patients are dealt with. It is allowing people to make their own choices to be able to say to the psychiatrist or psychologist I don’t agree with that treatment, I don’t think that is the one for me. Maybe we should try something else,” she explained.
However, the proposed change under the Mental Health Act is being vehemently opposed by Dr Bhamjee, who insists a mental health tribunal can be used to establish which patients are seriously ill and need specialist forms of psychiatrist help.
The former Labour Deputy who now works as a private consultant psychiatrist says most of his colleagues support ECT.
“This is our job. We are not playing God. When you have a pipe broken in your house, you don’t tell your plumber how it fix it. That is what the minister is telling us now. This change will set us back 150 years.
“There is no need to change the law. This is the job for psychiatrists. These are backward steps with the Mental Health Act. We are going too far the other way.
“Lives will be lost. This is a very strong but necessary statement before Department goes ahead with this and makes this mistake,” he warned.
“My views are shared with many members of the psychiatric profession. It is a legal and medical treatment that is there for a long time. It does work, it has worked and it shouldn’t be changed. I have saved lives by giving ECT. I have used regularly in the past. I believe in it. I have delivered it. I found a need in patients I was seeing. Other psychiatrists have found a need to give ECT as well. If you go to a doctor for a chest infection, you don’t tell him what he should administer,” he said.
While some opponents of ECT have described it as a “cruel” and “barbaric” therapy, Dr Bhamjee claimed new systems for delivering ECT have been modified and tested to the best international standards.
Internationally he said it was only banned in California where a person had to go before a judge who granted it. “It is not banned in England or America. It is up to psychiatrist to administer it where it is appropriate. Some psychiatric patients don’t have the capacity to say ‘yes’ or ‘no,  that is why we to make the decision for them,” he added.
A spokesperson for the Department of health said, “the Mental Health Act 2001 includes a range of safeguards to ensure that the rights of people who are admitted involuntarily for psychiatric care and treatment are protected.  The Act requires that a patient must consent in writing to the administration of ECT; however where a patient is unable or unwilling to give consent, the treatment may be administered if it has been approved by the consultant psychiatrist responsible for the care and treatment of the patient, and also authorised by another consultant psychiatrist. 
“While there are diverging views on the necessity and efficacy of ECT it remains a recognised treatment for severe mental illness.  
”Minister Lynch believes that reference to unwilling in Section 59 (1) (b) of the Act should be deleted and has undertaken to bring forward her own legislative proposals in the context of the current review of the Mental Health Act which, in line with the Programme for Government, will be informed by human rights standards.  The review is expected to be completed later this year”.