Administration of electroconvulsive therapy

Information for clinicians about when electroconvulsive therapy (ECT) orders can be made, when the therapy can be administered, application criteria for ECT and the role of the Chief Psychiatrist or delegate.

Administration of ECT

Electroconvulsive therapy may be administered for:

adults with decision-making capacity
adults without decision-making capacit
young people with decision-making capacity
young people without decision-making capacity.

It must not be administered to a person who is under 12 years old.

Adult with decision-making capacity

Therapy may be administered to an adult if they have decision-making capacity when they:

have given consent to the administration of ECT
have not withdrawn the consent, either orally or in writing
have not had therapy administered 9 or more times since the consent was given
have not had therapy administered if the consent was to the administration of ECT a stated number of times, less than 9.

Adult without decision-making capacity

ECT may be administered to an adult without decision-making capacity if the person has an advance consent direction consenting to ECT and it is administered in accordance with the direction and the person does not refuse or resist.

It can also be administered if it is in accordance with an ECT order or an emergency ECT which is in force in relation to the person and the person does not refuse or resist or a psychiatric treatment order or a forensic psychiatric treatment order is in force.

Young person with decision-making capacity

Therapy may be administered to a young person, who is at least 12 years old but under 18 years old, if they have decision-making capacity to consent to the administration of ECT.

ECT may be administered:

for a 12 to 15 year old if an ECT order is in force in relation to the person
for a 16 or 17 year old if an ECT order or an emergency ECT order in force in relation to the person
if the person has given consent to the administration of ECT
if the person has not withdrawn the consent, either orally or in writing.

Young person without decision-making capacity

ECT may be administered to a young person, who is at least 12 years old but under 18 years old, if the person does not have decision-making capacity to consent to the administration of ECT.

ECT may be administered:

for a 12 to 15 year old if an ECT order is in force in relation to the person
for a 16 or 17 year old if an ECT order or an emergency ECT order in force in relation to the person,
the person does not refuse or resist, or a PTO or a FPTO is also in force in relation to the person.

Application for an ECT order

If the Chief Psychiatrist or a doctor believes on reasonable grounds that the ACAT could reasonably make an ECT order in relation to a person, the Chief Psychiatrist or doctor may apply to the ACAT for an ECT order if the person is under 18 years old. The application must be supported by the evidence of another doctor and applicant must be a child and adolescent psychiatrist.

When ACAT can make an ECT order

The ACAT may make an ECT order for a person who is at least 12 years old if satisfied that:

the person has a mental illness
the person does not have decision-making capacity to consent to the administration of ECT
the person does not have an ACD refusing consent to ECT
the administration of ECT is likely to result in substantial benefit to the person
either all other reasonable forms of treatment available have been tried but have not been successful or the treatment is the most appropriate treatment reasonably available.

The ACAT may make an ECT order for a person who is at least 12 years old but under 18 years old if satisfied that:

the person has a mental illness
the person has decision-making capacity to consent to the administration of the therapy
the person consents to the administration of the therapy
the administration of ECT is likely to result in substantial benefit to the person.

Content of ECT order

An order states:

why the ACAT is satisfied that an ECT order is appropriate
the maximum number of times therapy may be administered to the person under the order. This may be no more than 9 times, or if the person has an ACD, not be more than the maximum number of times stated in the direction.

Application for emergency order

If the Chief Psychiatrist and a doctor believe on reasonable grounds that the ACAT could reasonably make an emergency ECT order in relation to a person, the Chief Psychiatrist and doctor may jointly apply for an emergency order in relation to the person.

When ACAT can make an emergency ECT order

The ACAT may make an emergency ECT order for a person who is at least 16 years old if satisfied that the person:

has a mental illness
does not have decision-making capacity to consent to the administration of ECT
does not have an ACD refusing consent to ECT

The order may also be made if the administration of ECT is necessary to:

save the person’s life
prevent the likely onset of a risk to the person’s life within 3 days
either all other reasonable forms of treatment available have been tried but have not been successful or the treatment is the most appropriate treatment reasonably available.

Content of emergency ECT order

An emergency order states the number of times that the therapy may be administered to the person – not more than 3 – and when the order expires. This is not more than 7 days after the order is given.

If an emergency order is in force in relation to a person and the ACAT makes an ECT order in relation to the person, the emergency order is no longer in force.

Records

A doctor who administers ECT must keep a record of the administration of the ECT, including:

whether the administration was in accordance with an order of the ACAT
if the person gave consent.

The doctor must give the record to the person in charge of the facility where the therapy was administered.

The person in charge of the facility must keep a record of ECT given for at least 5 years.