1. INTRODUCTION

Electroconvulsive therapy (ECT) has been used in Scotland for the past fifty years. It is viewed by the psychiatric profession as a safe and effective treatment which can be lifesaving. This view is not always shared by the general public whose opinions are generally formed and reflected by the negative portrayal of ECT in drama and documentary. Such concerns are not new and in the late 1970s led to a series of double-blind control studies (Brandon 1984; Freeman 1978; Johnson 1980; West 1981) which conclusively proved, in scientific controlled circumstances, that ECT successfully treats patients suffering from major depressive illness particularly those with psychotic symptoms such as delusions and hallucinations.

These research findings have done little to reassure the public. One important reason is a lack of confidence that general clinical practice adequately mirrors stringent research methodology. The lack of evidence on the safety and efficacy of ECT in routine clinical practice together with the lack of information on adherence to proper procedures has made it very difficult for the psychiatric profession in Scotland to respond to recent criticism which has come from individual high profile campaigns, the voluntary sector and the Mental Welfare Commission amongst others. While there has been no concerted effort to have ECT banned, as has happened in certain states in America, there are pressures to have its use so restricted that many people would be denied the benefits in ordinary clinical practice. Although systematic studies of those who have received ECT (Cheshire and Freeman 1986) show that most patients have a very positive view of treatment, these studies are largely ignored by the anti-ECT lobby and do little to reassure those individuals whose experience of ECT has been negative for whatever reason. The main concerns expressed are: ECT is an ineffective treatment and is inappropriately and over used; adequate consent is often not obtained; it causes unacceptable side-effects and is given preferentially to the old, disadvantaged and to women. There have been a number of recent parliamentary questions raising some of these concerns.

Nearly all of these claims can be refuted from scientific studies but not often by evidence from routine clinical practice. Prior to the CRAG-funded audit, there was no hard data about ECT in Scotland to respond to these criticisms. The National Audit of ECT consisted of a series of audit cycles to systematically answer most of the above concerns for Scotland as a whole