Clause 30
Mental Health Bill [Lords]
9:25 am
Tim Loughton (Shadow Minister (Children), Health; East Worthing and Shoreham, Conservative)
I beg to move amendment No. 9, in clause 30, page 19, line 29, at end add—
‘58B Treatment for patients under 18 requiring consent and a second opinion
(1) Subject to section 62 below, a patient under eighteen years shall not be given electroconvulsive therapy (whether or not he is liable to detention), unless a registered medical practitioner appointed as aforesaid (not being the responsible clinician) has certified in writing that—
(a) the patient is capable of understanding the nature, purpose and likely effects of that treatment, and has consented, and that having regard in particular to the likelihood of its alleviating or preventing a deterioration of his condition, the treatment should be given; or
(b) the patient is incapable of understanding the nature, purpose and likely effects of that treatment, and either—
(i) a person who has parental authority for the patient understands the nature, purpose and likely effects of that treatment and has consented to the treatment and that having regard to the likelihood of its alleviating or preventing a deterioration of his condition, the treatment should be given; or
(ii) the High Court has determined that having regard to the likelihood of its alleviating or preventing a deterioration of his condition, the treatment should be given;
(2) For the purposes of treatment given under this section either the registered medical practitioner responsible for the patient’s treatment or the registered medical practitioner providing the second opinion shall be a clinician with specialist training in child and adolescent mental health, defined in accordance with regulations prescribed by the Secretary of State.’.
Welcome back to the Chair, Mr. Cook. May I echo your comments about the evidence that you are receiving, which you are turning around remarkably quickly? I am sure that all members of the Committee are grateful for that. The transcript of the informal committee was turned out particularly quickly—I will call it that rather than “select committee”, as you referred to it, Mr. Cook, to save further debate on the subject. I also made sure that hon. Members were given it directly, so they have probably received two copies. I hope that it will prove to be useful for the remainder of our deliberations.
Electroconvulsive therapy—the subject of clause 30—has always been a contentious issue. The treatment is particularly controversial, and gives rise to a number of concerns when applied to children. Amendment No. 9 would inject some assurances about how ECT may in extremis be used for the benefit of children. The amendment is in my name, those of my hon. Friends and those of the Liberal Democrats. It endeavours to provide that ECT may only be given to under-18s with consent and a second opinion. The consent would be from the young person when they are capable of giving it, or that of a parent when they are incapable. The amendment would allow consent to be given by order of the court in the case of parents who do not feel comfortable with the responsibility of giving consent, or who might not make decisions in their child’s best interest. That would ensure that both young people’s and parents’ needs are protected.
It is difficult for parents who are asked about applying ECT to a vulnerable child who is going through a traumatic time to make a decision. We want to make the application procedure for ECT easier.
As it is, children and young people can have ECT on parental consent alone or, with a second opinion authorisation, it can be administered against their wishes and the wishes of the parents. ECT is an invasive treatment and the pre-legislative scrutiny Committee has expressed concerns about it, too. It can have a number of side effects, including short or long-term memory impairment.
The National Institute for Health and Clinical Excellence guidelines stipulate that
“ECT is usually reserved for cases where there is a perceived life-threatening situation or where extensive alternative treatments have failed. Without controlled trials, the evidence for its efficacy is limited.”
Everyone would agree that the adolescent brain is developing. Its structure is changing. We could have great debates about how the brain develops in the early years and how attachment can affect it. The brain of a teenager is certainly not fully developed, as I am sure parents of teenagers will concur.
I am not a clinician, but—technically—synaptic pruning, which is believed to be essential for the fine tuning of the functional networks of the brain, takes place throughout adolescence, as do changes to the frontal cortex. That is essential to functions such as response inhibition, emotion regulation, analysing problems and planning.