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back (Background) forward (Safety) Table of Contents 9 INCIDENCE OF USE Information regarding the incidence of ECT use in New York State is currently not required by the State. Information regarding equipment type, a provider registry (by classification) on), protocols utilized, consent procedures and demographic statistics need to be collected and reported in order to ensure that patient rights, safety protective measures and efficacy are comprehensively examined on an ongoing basis with regard to the administration, use, oversight and outcomes of ECT treatment in New York State. When the issue of ECT was brought to the Committee's attention, efforts were made by Committee staff to ascertain the prevalence of ECT use in New York State. It soon became apparent that such information was not available. The Committee requested the Office of Mental Health, Commission on Quality of Care for the Mentally Disabled and Mental Hygiene Legal Services, collect specified information. The Committee also reviewed an unpublished joint report by the New York State Psychiatric Institute and Columbia University, which summarized the results of a 1997 survey of ECT use in the greater New York Metropolitan area. In lieu of comprehensive statewide information regarding ECT, the Committee has compiled anecdotal information that provides a snapshot of ECT use in the State. NIH CONSENSUS STATEMENT, JUNE, 1985 The panel is concerned that there are only limited data on the manner and extent of ECT administration in the United States and on the training of personnel involved in it. A national survey should be undertaken to assemble basic facts about the status of ECT treatment (NIH. I H. p. 10). ECT PRACTICES IN THE COMMUNITY (an unpublished report) The 1997 study, completed by the Departments of Biological Psychiatry and Clinical and Genetic Epidemiology at the NYS Psychiatric Institute and Departments of Psychiatry and Radiology, College of Physicians and Surgeons, Columbia University, stated that ECT is utilized in the U.S. far more in private and academic medical facilities than in public sector hospitals. The report elaborates that "Age, income and race are powerful predictors of ECT utilization in the U.S. which is higher among older, more affluent, and white patients ... The greater utilization in older patients has been attributed to the high presentation in this group of medical intolerance ... The greater use of ECT in non-minority populations and those of higher income is unexplained" (p. 3). In addition. the report found that: Nine of the 59 reporting facilities treated 58% of the patients receiving ECT in the Greater Metropolitan New York City area. The majority of patients were greater than 60 years of age. No facility reported treating children under age 13 and ECT use among adolescents from ages 13-18 years was extremely rare. The great bulk of ECT was performed exclusively on an inpatient basis. The high volume ECT facilities were more likely to utilize outpatient ECT. 10 On average, 46.2% of patients had cognitive impairment following ECT. Recent literature suggests that relapse rates in the year following ECT may be 60% and higher. The facilities estimated that the relapse rate is only 20.2%, a striking contrast. Dr. Harold Sackeim, Chief of Biological Psychiatry at the New York State Psychiatric Institute, member of the APA's Task Force Committee on Electroconvulsive Therapy, and co-author of the Task Force report and more than 200 other publications relating to ECT, testified at the May 2001 public hearing. Dr. Sackeim stated there are no known statistics on the use of ECT in NYS. However, based upon the 1997 survey, he surmised that the 59 respondent facilities average 51 patients annually for ECT treatment (which totals 3,009 individuals). Dr. Sackeim advised, given his best estimate, that approximately 100,000 patients receive ECT per year in the U.S., and proportionately nearly 7,000 NYS residents receive such treatment annually. Dr. Sackelm cautioned that his figures are likely to be conservative given higher rates associated with ECT use concentrated in metropolitan areas. On April 12, 2001, the MHLS, at the request of the Committee, reported on the collection of statewide statistics on applications for court orders authorizing ECT. While stating there may be a few cases not captured due to minor variations at the field staff level in the coding of treatment proceedings, the MHLS noted a 73% increase in applications in 1999 to 2000, from 59 to 97. Since 1997, applications for court orders authorizing ECT increased by 125% (43 to 97). The MHLS stated that more often than not, ECT is administered without court involvement. Additionally, MHLS advised it is not routinely notified when a patient does not object or when the ECT is performed per the patient's consent or in instances when someone other than the patient grants consent on their behalf without judicial intervention. On June 1, 2001, OMH provided the Committee with limited demographic information regarding ECT use. The Committee requested additional information, which was received in June 2001 and summarized below: Five of OMH's 27 facilities currently provide ECT on site and 12 facilities used offsite providers in calendar year 2000. The five OMH operated facilities, which provide ECT on site, are in compliance with APA guidelines. A total of 1-3 134 inpatients received ECT during calendar year 2000 (CY2000). Of the 134 individuals in OMH facilities receiving ECT in CY2000, 26% were court ordered. Since 1998, the number of court ordered ECT procedures increased by 52%. During (1998-2000). the distribution by gender was 45% male and 55% female. By age, the distribution was 33% for persons 18-44 years, 43% for ages 45-64 and 24% for recipients 65 and older. In CY2000 there was one patient, age 17 years and 8 months, in a children's facility who received ECT. According to SPARCS data from the New York State Department of Health, the rate of ECT was as 1.81% (1,822 individuals) of the total number of persons served in non-OMH facilities in CY2000. SURVEY OF THE PROVISION OF ELECTRO-CONVULSIVE THERAPY AT NEW YORK STATE PSYCHIATRIC CENTERS, COMMISSION ON QUALITY OF CARE, AUGUST 7, 2001 On October 2, 1-001, the CQC forwarded the Committee its report, "Survey of the Provision of ElectroConvulsive Therapy at New York State Psychiatric Centers," dated August 7, 2001, which reflected its findings from the most recent survey conducted on the provision of ECT at New York psychiatric centers. Following are report excerpts: The purpose of this survev was to obtain information about the frequency of administration of this treatment, facilities' management of such, and the patients who undergo this treatment, but not to evaluate its efficacy. As a result, the Commission obtained information about facilityspecific procedures governing the use of ECT, protocols for privileging physicians to administer the procedure, and demographic information regarding age, gender, diagnosis and capacity to consent for those persons receiving ECT in state psychiatric centers between June 1, 1999 and May 31, 2001 ... ECT is currently administered in Manhattan Psychiatric Center, Creedmoor Psychiatric Center, Pilgrim Psychiatric Center, the Psychiatric Institute (PI), and Rockland Psychiatric Center (p. I). The Commission identified 164 patients that had received ECT during the timeline within 1999-2001 as outlined above. Excluding Pl, where all ECT patients are voluntary participants in a research protocol, approximately 40% are receiving ECT pursuant to court orders. The CQC found that ECT was not administered to children at state psychiatric centers and was given to women (62%) more often than men (38%). HILLSIDE HOSPITAL On June 26, 2001. the Committee requested OMH conduct a formal investigation of the use of ECT at Hillside Hospital in Queens. This request followed articles appearing in the New York Post alleging that patients at Hillside Hospital were being given ECT as a behavioral modification mechanism and that patients had been coerced to agree to ECT. On February 8, 2002, OMH staff verbally reported the findings of this investigation to Committee staff. During the period of January 1999 through July 2001, a total of 360 inpatients received ECT, of which one person was retarded, another autistic and one other diagnosed with delirium. Moreover, 10 of the 360 inpatients were adolescent recipients of ECT between the ages of 14 -17. While OMH did not find evidence to support the allegations reported in the New York Post, it is continuing its review of ECT practices at Hillside in response to questions raised by Committee staff at the February 8. 2002 briefing. |
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