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UK mental health law violates United Nations treaties, putting women and teenagers at serious risk of torture and brain damage

In March 2023, the Independent newspaper announced that Members of Parliament (MPs) across the political parties were calling for a ban on the use of electroconvulsive therapy, also known as electroshock treatment and ECT. 

Between 2,500 and 5,000 people in the UK receive the treatment each year. MPs have voiced serious concerns that women are disproportionally given ECT and that patients are not properly notified of the damaging side effects of the controversial procedure. The practice sends hundreds of volts of electricity through the brain causing a grand mal seizure.¹ The Citizens Commission on Human Rights (CCHR), the oldest global international mental health industry watchdog, supports the ban, adding that electroshock is brain-damaging and a recognised form of torture. 

Teenagers are also being subjected to electroshock. Psychiatrist Joanna Moncrieff stated, “We know it can cause permanent memory loss, so it suggests it may do permanent damage. We know younger brains are more vulnerable to drugs, for example, so they are likely to be more damaged by ECT.”²

CCHR says just as women comprised the majority of witches executed in the 1600s-1700s, women are the major recipients of electroshock.³  In 2019, the Independent revealed that women comprise around two-thirds of all patients receiving ECT in the UK.⁴

An Ontario Institute for Studies in Education in Canada study determined, “Repeatedly, women’s testimonies connote a sense of the entire process as an ongoing assault: being strapped down, being herded into the room, one’s head being encased in a band, being unable to breathe, being rendered unconscious, having one’s body violated by shock, being brain damaged.” Further, electroshock “functions and is experienced as a form of assault and social control, not unlike wife battery.”⁵

Despite an anaesthetic and muscle relaxant administered before the electroshock—to prevent bones breaking—the study was clear: “Although the medicalisation camouflages the assault, overwhelmingly electroshock constitutes an assault on women’s memory, brains [and] integral being.”⁶

A spokesperson for the Department of Health and Social Care defended the use of ECT, saying it is “closely regulated” under the Mental Health Act (MHA), and that the department expected healthcare professionals and services to follow National Institute for Health and Care Excellence (NICE) guidelines for ECT, which are kept under “regular review.”⁷  

CCHR however refutes this.

Failed Regulation & Monitoring

• In January 2016, the NHS Digital “SnoMed” was introduced to enable providers to record “anything they want” about ECT use, including non-consensual ECT rates. That data however could not be effectively evaluated. Neil McCrirrick, Head of Information Assurance for NHS Digital said, “When we see ECT [numbers] in SnoMed, we don’t know if that’s ECT in relation to one unique patient or more than one.”⁸
• In 2017, the Guardian reported figures it obtained through the Freedom of Information Act that covered four-fifths (44) of NHS mental health trusts in England. It requested data from all NHS mental health trusts, as listed by the Care Quality Commission for a 10-year period between 2005-06 and 2015-16.  As discovered, it was clear many trusts either did not hold or could not access relevant data for the decade covered by the request. The vast majority could not provide data for the full 10-year period requested.⁹
• In July 2018, the NHS Digital announced it was no longer placing the monitoring of rising ECT as a priority, due to constrained resources.¹⁰ Four months later Mental Health Today further exposed the flawed reporting system. NHS Digital admitted it had lost control of the recording of non-consensual ECT delivered in mental health hospitals in the three years since 2015.¹¹  
• In a March 2021 study of NHS Trust monitoring and use of ECT, only 37 NHS trusts (66%) responded, of which 37% indicated ECT was still given without consent, and 18% of Trusts were non-compliant with legislation concerning second opinions. The study authors stated, “Given the apparent failure of current monitoring and accrediting of ECT clinics in England, by the Royal College of Psychiatrists’ ECT Accreditation Service (ECTAS), an independent government sponsored review is urgently needed.”¹²

The failure to regulate and monitor ECT usage is even more egregious factoring in the United Nations (UN) treaties that the UK has ratified—adopted as law—that for a decade have called for a prohibition of forced use of ECT.  UK data indicates that around 40% of ECT is non-consensual, performed on individuals detained against their will under the MHA.¹³ Mental Health Today reported that for 2013-14, ECT was carried out 14,496 times on 1,447 members of the public, typically detained against their will in hospital under the Mental Health Act.¹⁴ 

Mental Health Act Endorses Torture

The UK has ratified the following UN treaties, which specify “No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.”¹⁵

• Convention on the Rights of Persons with Disabilities (2009, Article 1)
• Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT) (1988, Article 16)¹⁶ 
• International Covenant on Civil and Political Rights (1976, Article 7);  and 
• Universal Declaration of Human Rights (1951, Article 5).  

In 2013, the UN Special Rapporteur on Torture put countries on notice when he called for a ban on forced treatment such as “psychosurgery, electroshock and mind-altering drugs such as neuroleptics, [and] the use of restraint and solitary confinement, for both long- and short-term application.”¹⁷

In 2019, nearly 80 UK civil society groups and experts submitted evidence to the UN Committee against Torture, revealing wide-ranging failures by the UK to meet its international obligations to prevent torture and ill-treatment, which included that “an increasing number of people are being detained under the Mental Health Act, with a 36% rise in the number of detentions since 2010.”¹⁸

[T]he term “torture“ means “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person….”¹⁹ In 2022, a New Zealand Royal Commission Inquiry into Child Abuse in Institutions further defined torture in relation to mental health treatment, including electroshock. The legal definition of torture has three elements, it said:

(1) the infliction of severe pain and suffering,

(2) by a person acting on behalf of the State,

(3) for the purpose of punishment.²⁰

Arguably, any electroshock treatment—with its painful, debilitating and often permanent side effects constitutes torture, especially when those administering it are protected by law.

The MHA violates the UN Treaties relating to torture, or cruel and degrading treatment. If a person is detained in hospital under section 3 of the Act (involuntarily committed or “sectioned”²¹) they can be subjected to electroshock without consent in an emergency.²²

What constitutes emergency is arbitrary opinion and open to abuse.  Under the Act, ECT is argued as necessary where: It will save your life.  

However, there are no clinical studies proving electroshock saves lives but on the contrary, it may induce suicide. A recent study published in Acta Psychiatrica Scandinavica found that after receiving electroshock, patients were 44 times more likely to die by suicide than people in the general population. Researchers at Aarhus University in Denmark used nationwide registers and identified all patients that initiated ECT between 2006 and 2016. Among the patients who received electroshock, 161 (1.4%) died from suicide within two years—electroshock patients had a substantially elevated suicide rate.²³

Psychologist John Read, Ph.D. and psychiatrist Joanna Moncrief conducted a meta-analyses of ECT studies titled, “Depression: why drugs and electricity are not the answer,” in which they were unable to identify any evidence that ECT prevents suicide, as often claimed. Numerous studies have found ECT recipients are more likely than other patients to kill themselves.²⁴

In a 2020 study, 14,810 ECT patients were 16 times more likely to try to kill themselves than a matched control group of 58,369. And a 2021 US study found that 1,524 homeless US veterans who received ECT had made significantly more suicide attempts, at 30 days follow up, than 3,025 matched homeless veterans who hadn’t had ECT.²⁵

Electroshock Causes Brain Damage

The MHA also defines an emergency as “If it will prevent your condition seriously worsening, and won’t have unfavourable physical or psychological consequences that can’t be reversed.”²⁶  

However, according to Read, “Given the well-documented high risk of persistent memory dysfunction, the cost-benefit analysis for ECT remains so poor that its use cannot be scientifically, or ethically, justified.” ²⁷ 

It is irrefutable that ECT causes memory loss, cognitive disability and brain damage. Wisner-Baum, a US law firm that has successfully litigated ECT civil cases, reports, “ECT can cause brain damage, permanent memory loss and neurocognitive injury,” “there are no long-term studies that show ECT is safe or effective” and “the procedure continues to deliver a significant amount of electricity to the human brain, resulting in damage.”²⁸

The MHA must only go in the direction of prohibiting the use ECT.  But a Department of Health and Social Care representative told the Independent in March 2023, that in the draft Mental Health Bill, they are looking to merely strengthen safeguards by “requiring that the clinician gets approval from a second opinion appointed doctor before treatment can be administered.”²⁹

This self-serving “safeguard” already exists and is appallingly inadequate, and not in compliance with UN and World Health Organization (WHO) direction. The WHO Guidelines on mental health, issued in June 2021, pointed to the Convention on the Rights of Persons with Disabilities which “bans forced admission and treatment.” This significantly challenges countries that allow involuntary admission under grounds such as “a need for treatment,” “dangerousness” or “lack of insight.”³⁰ 

In a joint statement issued in May 2021, the UN Committee on the Rights of Persons with Disabilities, two UN Special Rapporteurs, and an array of experts said the “growing consensus” within the UN and WHO is that the coercive approach to mental health is “doing harm” and forced admission and treatments in institutions brings “harmful effects such as pain, trauma, humiliation [and] shame….”³¹

Richard Bentall, professor of clinical psychology at Liverpool University said: “My view is that ECT is a classic failure of evidence-based medicine. I don’t believe that there are adequate clinical trials of ECT to establish its effectiveness.” Further, “It is clearly unethical to pass electric shocks across people’s brains unless it is effective [and] helpful to do so and therefore there is an ethical requirement to show that treatment is effective.”³²

Clinical psychologist Craig Newnes, author of A Critical A-Z of Electroshock, says, “The biggest mystery of all is why on Earth people think that putting bolts of electricity through people’s heads is a good idea.” Further, “People often ask, ‘What is electroshock?’ And what it is, is electrocution. That’s all it is.”³³

Australian psychiatrist Niall McLaren writing in Ethical Human Psychology and Psychiatry about “Electroconvulsive Therapy: A Critical Perspective,” said that “whether patients receive ECT or not is not a matter of science, it is a matter of the psychiatrist’s personal predilection, meaning chance.”³⁴ “Suggestions that it is “useful, valuable and clinically indicated” are personal judgments only, devoid of any empirical content.”³⁵

McLaren sums it up by warning that any psychiatrist who tells a patient, “‘You need ECT’ is really only saying, ‘I don’t know what else to do.’ I will repeat: No psychiatrist needs to use ECT.”³⁶

It is imperative that ECT is prohibited as an unnecessary and potentially dangerous procedure.