Electroconvulsive therapy order

Electroconvulsive therapy (ECT) is a medical procedure that can be used for the treatment of severe psychiatric disorders such as depression or bipolar disorder.

ECT is mainly used in adults, to treat serious illnesses that have not responded to other interventions. It is rarely used in young people under the age of 18 and cannot be given to a person under the age of 12.

The therapy is given in an approved mental health facility by a qualified doctor and may only be administered to an adult when you give informed consent, or the ACT Civil and Administrative Tribunal (ACAT) makes an order or emergency order.

Consent for therapy

You must have decision-making capacity to give informed consent. Informed consent must be in writing, signed, and given freely and voluntarily.

You can withdraw consent at any time.

In limited circumstances, ECT can be given under the Act without written consent if:

• you do not have decision-making capacity to consent
• you have an advance consent direction in which you consent to therapy, and it is given in accordance with your direction, and you do not refuse or resist
• an order is made by the tribunal, and you do not refuse or resist, or you are subject to a psychiatric treatment order.

Understanding an order

An ECT order is a legal document made by that allows therapy to be given if:

• you are over 12 years old
• you have a mental illness
• you do not have decision-making capacity to consent
• you do not have an advance consent direction refusing therapy
• the therapy is likely to help you, and all other reasonable forms of treatment available have been tried, or ECT is the most appropriate treatment available.

How an order is made

The Chief Psychiatrist or a doctor can apply to for an order. Before making an order, ACAT will hold a hearing. When making an order, the tribunal will consider:

• whether you consent and have the decision-making capacity to consent to therapy
• wishes in your advance consent direction if you have one
• opinions of people who care for you day to day
• opinions other people who attend the hearing
• opinions of your guardian, power of attorney, nominated person or health attorney’s
• what the people who have parental responsibility for you think if you are between 12-18 years old
• if any of your medical history is relevant, and any other options for treatment that are available, including the aim of that treatment, its benefits and whether it is likely to be upsetting, cause discomfort or side effects, and whether it has risks.

Consultation

Wherever possible the tribunal will talk to you and the following people, if they are involved in your care:

• your parents, or those who have parental responsibility, if you are a child
• your guardian if you have one
• the person who holds power of attorney for you
• your nominated person
• your health attorney

Information in an electroconvulsive therapy order will say:

• whether you have a mental illness
• whether you do not have decision-making capacity to consent to the therapy
• whether you consent to the therapy
• whether it is likely to result in benefits to you
• how many times you can have it.

Up to 9 treatments can be given in one course of ECT. If further treatment is required, another order can be applied for.  The procedure will be explained to you in a way that you are likely to understand.

As soon as possible after making an order, ACAT will give a copy of the order to you, the person who applied for the order and the people the tribunal spoke to about the order.

Emergency order

An emergency electroconvulsive therapy order is a legal document made by the tribunal that means therapy can be given as an emergency treatment under specific conditions. The Chief Psychiatrist and another psychiatrist can apply for an emergency order, which allows you to have therapy if:

• you are over 16 years of age
• you have a mental illness
• you do not have decision-making capacity to consent to the therapy
• you do not have an advance consent direction refusing therapy
• you need therapy to save your life or to prevent risk to your life that is likely within 3 days
• all other reasonable treatments available have been tried or this the most appropriate treatment available.

When making an emergency order, the tribunal will talk with the same people it would talk to when making an ECT order.  Under an emergency order, therapy cannot be given more than 3 times within the duration of the order, being 7 days.