The ECT Accreditation Service (ECTAS)
In the early 1980s there was an editorial in The Lancet entitled ‘ECT in Britain: a shameful state of affairs’ (Lancet, 1981). This was at a time when ECT was the main target of the anti-psychiatry movement and there were regular protests outside Royal College of Psychiatrists’ meetings about the use of ECT. Paradoxically, several of the UK randomised controlled trials of ECT had been published and others were under way, so the evidence base for the efficacy was stronger than it had ever been. The College had just completed its first survey of the use and practice of ECT, concluding that standards of practice were low, equipment was outdated and regional variations were enormous. The author of The Lancet editorial concluded that it was not ECT that was bringing psychiatry in disrepute, it was psychiatrists and the way they practised.
The College conducted further surveys of practice in the late 1980s and early 1990s, sadly showing that standards were improving little. The Special Committee on ECT (now Special Committee on ECT and Related Treatments) began running regular training courses which several thousand psychiatrists have now attended. More recently there have been increasing numbers of anaesthetic and nursing delegates.
Thirty years on, we now have a third edition of The ECT Handbook, guidelines from NICE endorsing the use of ECT (National Institute for Clinical Excellence, 2003; National Collaborating Centre for Mental Health, 2010) and we have ECTAS.
Over the first 20 years the rate of ECT steadily fell and if the slope had not levelled out it would have crossed zero in 2012. This did not happen, and the past 10 years have shown a levelling of the rates of giving ECT, with some areas showing a rise. National figures are no longer collected. This contrasts with the situation in North America, where the rates of ECT use have been rising, and raises the view that ECT may be underused, causing patients with severe and chronic depression to suffer for much longer, as antidepressant after antidepressant is changed.
Whatever the future of ECT, it is vitally important that when it is given, it is given appropriately, safely and with due concern to a patient's consent and dignity. The ECT Accreditation Service aims to assure and improve the quality of the administration of ECT.