How Accurate Are ECT Patient Information Leaflets Provided by Mental Health Services in England and the Royal College of Psychiatrists? An Independent Audit

Abstract

BackgroundThe aims of this paper were to assess the accuracy of patient information leaflets about electroconvulsive therapy (ECT) in England, and assess compliance with National Institute for Health and Care Excellence (NICE) recommendations, and the principle of informed consent.MethodsFreedom of Information Act requests were sent to 51 National Health Service Trusts for a copy of their information leaflet. These, and three Royal College of Psychiatrists (RCPsych) leaflets, were scored on a 40-item accuracy measure.ResultsThirty-six Trusts (71%) provided leaflets. The number of accurate statements, from a possible 29, ranged from four to 20, with a mean of 12.8. The most commonly omitted accurate statements included: that previous treatments, including psychological therapy, should be tried first (mentioned by 12 Trusts); cardiovascular side effects (6); lack of long-term benefits (6); patients' right to take 24 hours to consider giving consent (1); memory loss higher in women and older people (0). The number of inaccurate statements averaged 5.8, out of 11, and ranged from two to nine. The most common inaccurate statements included: ECT corrects biological deficits (28); misleading claims of very low mortality risk (28); minimization of memory loss (23); claims that ECT saves lives (22); claims of very high improvement rates (19). The current (2020) RCPsych leaflet contained seven inaccurate statements and scored worse than two previous RCPsych leaflets.ConclusionsInformation leaflets about ECT comply neither with NICE recommendations nor the principle of informed consent. Patients are being misled about the risks they are taking and the limited nature of ECT's benefits.