Electroconvulsive treatment

Electroconvulsive treatment (ECT) is a safe and effective treatment for some mental illness, particularly severe depression and other mood disorders.

When can ECT be performed?

ECT can be performed on an adult, regardless of whether that adult is receiving mental health services on a voluntary or a compulsory basis if:

• the adult has given informed consent. Consent must be given personally and in writing. No guardian, parent or other substitute decision-maker may consent to ECT on behalf of an adult; or
• if the person does not have capacity, the Mental Health Tribunal has made an order authorising a course of ECT for the person

ECT can be performed on young people, that is people under 18 years of age, if the Mental Health Tribunal has made an order authorising a course of ECT.

The requirements for authorisation for ECT vary depending on whether the person is an adult (18 years or over) or a young person (under 18 years) or if the person is a patient.

Patient is a term used in the Act to refer to a person who is:

• subject to
  • an assessment order; or
  • a court assessment order; or
  • a temporary treatment order; or
  • a treatment order; or
• is a forensic patient; or
• is a security patient

For more information on these terms, see Terms and definitions

Summary of authorisation requirements for ECT

Adult patients

The patient provides informed consent in writing to ECT.

Or the Mental Health Tribunal authorises a course of ECT on being satisfied:

• the patient does not have capacity to provide informed consent to ECT; and
• there is no less restrictive way for the patient to be treated.

Adults who are not patients

The person provides informed consent in writing to ECT.

Or the Mental Health Tribunal authorises a course of ECT on being satisfied:

• the person does not have capacity to provide informed consent to ECT; and
• the person has an instructional directive consenting to ECT or the person’s medical treatment decision maker has given informed consent to ECT; and
• there is no less restrictive way for the person to be treated.

Young patients

The Mental Health Tribunal authorises a course of ECT if the young patient has given informed consent in writing to ECT.

Or the Mental Health Tribunal authorises a course of ECT on being satisfied:

• the young patient does not have capacity to provide informed consent to ECT; and
• there is no less restrictive way for the young patient to be treated.

Young people who are not patients

The Mental Health Tribunal authorises a course of ECT if the young person has given informed consent in writing to ECT.

Or the Mental Health Tribunal authorises a course of ECT on being satisfied:

• the young person does not have capacity to provide informed consent to ECT; and
• the young person’s medical treatment decision maker has given informed consent in writing to ECT; and
• there is no less restrictive way for the young person to be treated.

Application to the Mental Health Tribunal for authority to perform a course of ECT

An authorised psychiatrist may apply to the Mental Health Tribunal for authority to perform a course of ECT on:

• an adult patient if:
  • the patient does not have capacity to give informed consent to receiving ECT; and
  • the authorised psychiatrist is satisfied that there is no less restrictive way for the patient to be treated
• a young patient if the young patient has personally given informed consent to receiving a course of ECT; and
• a young patient if:
  • the young patient does not have capacity to give informed consent to receiving ECT; and
  • the authorised psychiatrist is satisfied that there is no less restrictive way for the patient to be treated.

A psychiatrist may apply to the Mental Health Tribunal for authority to perform a course of ECT on:

• an adult person (who is not a patient) if:
  • the person does not have capacity to give informed consent to receiving ECT; and
  • the person has an instructional directive giving informed consent to ECT or the person’s medical treatment decision maker gives informed consent in writing to a course of ECT; and
  • the psychiatrist is satisfied that there is no less restrictive way for the person to be treated;
• a young person (who is not a patient), if the young person has personally given informed consent to receiving a course of ECT; and
• a young person (who is not a patient) if:
  • the young person does not have capacity to give informed consent to receiving ECT; and
  • the young person’s medical treatment decision maker has given consent in writing to the course of ECT; and
  • the psychiatrist is satisfied that there is no less restrictive way for the patient to be treated.

In deciding that there is no less restrictive way for a person (regardless of age and whether they are a patient or not) to be treated, the authorised psychiatrist or psychiatrist (as the case may be) must have regard to:

• the person’s views and preferences about ECT, and any beneficial alternative treatment that is reasonably available and the reasons for those views and preferences, including any recovery outcomes the patient would like to achieve
• whether the ECT is likely to remedy or lessen the symptoms of mental illness
• the likely consequences for the person if ECT is not administered any psychiatric opinion that has been given by another psychiatrist (including any second psychiatric opinion given to an authorised psychiatrist if the person is a patient)
• the views of the person’s guardian, if they have one
• the views of any carer, if the psychiatrist or authorised psychiatrist is satisfied that the decision will directly affect the carer or care relationship
• if the person is a patient – any views and preferences expressed in an advance statement of preferences and by the patient’s nominated support person
• if the person is not a patient – any relevant values directive given by the person and the views of the person’s medical treatment decision maker and support person
• the views of a parent of the person, if the person is under the age of 16 years
• the views of the Secretary to the Department of Families, Fairness and Housing if the person is the subject of a relevant child protection order.

For more information on these terms, please see Terms and definitions.

A psychiatrist or authorised psychiatrist will have fulfilled this obligation if reasonable attempts are made to find out the views of those listed above even if they are not able to obtain the views of all. What is reasonable in the circumstances will vary on a case-by-case basis as will the weight that should be given to these views in making the determination.

Mental Health Tribunal authorisation for performance of ECT

The Mental Health Tribunal must list a hearing within 5 business days of an application for authority to perform ECT and will make an order authorising a course of ECT if satisfied, that the application relates to:

• an adult patient, where the patient does not have capacity to provide informed consent to ECT and there is no less restrictive way for the patient to be treated
• an adult who is not a patient, where the person does not have capacity to provide informed consent to ECT and the person has an instructional directive consenting to ECT, or the person’s medical treatment decision maker has given informed consent to ECT, and there is no less restrictive way for the person to be treated
• a young patient, where:
  • the young patient has given informed consent in writing; or
  • the young patient does not have the capacity to provide informed consent to ECT and there is no less restrictive way for the young patient to be treated.
• a young person who is not a patient, where:
  • the young person has given informed consent in writing; or
  • the young patient does not have capacity to provide informed consent to ECT and the young person’s medical treatment decision maker has given informed consent in writing to ECT and there is no less restrictive way for the young patient to be treated.

If not satisfied of the relevant matters, the Mental Health Tribunal will refuse to authorise ECT.

In making an order authorising ECT, the Mental Health Tribunal must specify details of the course of treatment, being the number of treatments to be performed (which can be up to 12) and the period within which the treatments must be performed (which cannot be longer than 6 months).

There is no requirement that a course of electroconvulsive treatment be completed.

Urgent application to perform ECT

An authorised psychiatrist or psychiatrist may request an urgent hearing of an application for ECT if satisfied that the course of ECT is necessary as a matter of urgency to:

• save the life of the person for whom the application is made
• prevent serious damage to the health of the person
• prevent the person from suffering or continuing to suffer significant pain or distress.

The Mental Health Tribunal must list and complete a hearing of an urgent application as soon as practicable after receiving the request.

Once the Mental Health Tribunal has made a decision regarding an ECT application

As soon as practicable after the Mental Health Tribunal makes an order or refuses an application to make an order authorising a course of ECT, the Tribunal must notify the psychiatrist or authorised psychiatrist who made the application.

The Tribunal must also notify:

• the person in respect of whom the application was made
• the person’s carer, if the Tribunal is satisfied that the making of the order will directly affect the carer and the care relationship
• the person’s guardian, if they have one
• a parent, if the person is under the age of 16 years
• the Secretary to the Department of Families, Fairness and Housing if the Secretary has parental responsibility for the person under a relevant child protection order
• if the person is a patient, the person’s nominated support person, if they have one
• if the person is not a patient, any medical treatment decision maker who gave informed consent to the ECT and the person’s support person if they have one.

The Tribunal must take reasonable steps to ensure each of these people who have been notified are given a copy of the order. The authorised psychiatrist who applied for the order must take reasonable steps to ensure that each of these people who have been notified are given a copy of the relevant statement of rights.

For more information on these terms, see Terms and definitions.

Beginning and end of a course of ECT

A course of ECT begins on the date it is authorised by the Mental Health Tribunal.

The course of ECT ends when any of the following occurs:

• all of the authorised treatments have been performed
• the date by which the course of treatment must be completed is reached
• the psychiatrist or authorised psychiatrist determines that ECT is no longer the least restrictive treatment available
• the person’s legal status changes – that is,
  • a person who was not a patient becomes a patient (that is a person is made subject to an order that authorises compulsory assessment or treatment); or
  • a person who was a patient ceases to be a patient
• a young person reaches 18 years of age
• a person who had an order made on the basis that they did not have capacity to consent to ECT regains capacity to give informed consent
• a medical treatment decision maker who provided consent to ECT withdraws that consent
• a new order authorising ECT is made for the person.

A psychiatrist or an authorised psychiatrist may apply to the Mental Health Tribunal for a further order authorising a course of ECT for a person during or after a course of ECT.

Reporting on the use of ECT

An authorised psychiatrist applying for and/or providing ECT for a person must give a written report to the Chief Psychiatrist in relation to any matter requested within any timeframes set by the Chief Psychiatrist.

Transitional arrangements

A course of ECT authorised before 1 September 2023 continues to apply as though the authorisation was made under the Mental Health and Wellbeing Act 2022.