‘Changing patterns of bloodflow to the brain with ETC can give people their lives back’
Electro-convulsive therapy (ECT) is one of the most misunderstood treatments in our health service.Here, the Royal College of Nursing in Wales explains what it is and why it’s so beneficial to patients
IT’S a treatment which carries a great deal of stigma and has suffered at the hands of some Hollywood movies. But electro-convulsive therapy, more commonly known as ECT, is still being used with great effectiveness among mental health patients in Wales.
It involves sending an electric current through the brain to trigger an epileptic seizure to relieve the symptoms of some mental health problems.
Experts say it leads to “diverse changes” in brain function, cerebral blood flow, metabolism and neurotransmitter pathways.
The treatment is given under a general anaesthetic and using muscle relaxants, so a patient’s body does not convulse during the seizure.
Some patients report feeling significantly improved after a single session, while others take a little longer to benefit from this particular form of therapy.
And some later relapse and need further sessions to get back on an even keel.
Clinic manager Kara Hanningan said she sees positive results every day from the treatment she manages. But she said it remains a therapy that few people understand or even want to know anything about.
Kara, who is dual-trained as an adult field nurse and a mental health nurse, knows that the reality is a long way from the image that most people have of it.
“People even ask me if it is still being done,” said Kara, who is at pains to point out that as well as still being a part of modern mental health treatment, the benefits for people with the kind of deep clinical depression that leaves them unable to care for themselves, can be startlingly successful. “People are afraid of ECT because their opinions are informed by what they have seen in films and on television.
“The reality is quite different, and for people who have experienced it and find themselves sliding back into depression, they will often request the treatment.”
The clinic has been described as “a welcoming place” where friends and family are actively encouraged to visit.
And because patients are anaesthetised before the treatment their support is required in the 24 hours that follow.
ECT treatment itself lasts between 20 and 50 seconds, with the patient being “under” for around five minutes.
They are allocated a high-intensity team which often includes a consultant anaesthetist, anaesthetic practitioner, consultant psychiatrist, a junior psychiatrist, an ECT nurse and a recovery nurse or practitioner.
Most people are up and about and eating breakfast within half an hour.
“Some patients have response.
“It can be quite miraculous and you can see very rapid positive results.
“It’s lovely to see really poorly people become really well. They usually have two sessions a week for a few weeks. We assess them thoroughly before the start of the treatment – and at the end and then do a three-month follow-up.
“It’s not necessarily a suitable treatment for everyone with mental health issues, but for those that are – and they would always already be receiving psychiatric care and have already undertaken treatments like talking therapies and medication – it can be life-changing,” said Kara. “Despite its negative image it really can give people their lives back.”
It remains unclear as to why ECT works, but it is known to change patterns of blood flow in the brain and also change the way energy is used in parts of the brain that are thought to be an immediate involved in depression. It may also cause changes in brain chemistry, although how these are related to symptoms is not understood.
Kara manages the Cardiff and Vale ECT clinic at University Hospital Llandough, and was a finalist in the 2017 Royal College of Nursing in Wales Mental Health and Learning Disability Nurse of the Year Awards.
She received her award in recognition of the work she has done in improving standards of care for ECT patients, not only in her own health board but across the country as part of her work with the All-Wales ECT Network (AWEN).
This, in turn, links in with NALECT – the National Association of Lead Nurses ECT and connects nurses practising in the field, striving to find ways to improve the service and nurse education – working closely with ECTAS ECT accreditation service which is an initiative of the Royal College of Psychiatrists centre for quality improvement.
“Our remit is the work at national level to improve and promote better standards for ECT care,” she said.
And sometimes that promotional work extends to other NHS practitioners who do not understand what ECT is all about or how beneficial it can be to that particular group of patients.
■ Nurses like Kara are making a huge, positive impact on patient care across Wales and the Royal College of Nursing in Wales wants to recognise their contribution.
■ Nominations are now open for the RCN Wales Nurse of the Year Awards 2018. Find out more at www.rcn.org.uk/wales/getinvolved/awards