In about April last year, I thought it would be a good idea to find out how much the Qld Mental Health Review Tribunal (MHRT) costs to run. Why would anybody bother? Well, it seemed to me that however much they cost, it was a lot of money for an institutional process that, in the bad old days, cost nothing. So I checked their annual report and found that they burn through $19million a year. That was compiled about two years ago so it would be more today. That's a lot of money, it would build a lot of social housing each year, year after year.
We can talk about tribunals another day as an item in their annual report caught my eye. We have run, boasted the elegant report, an educational program for the members of the tribunal. That's good, because there's a lot of law involved. But this item wasn't about law, it was a lecture given to the worthy members of the tribunal on electro-convulsive treatment, or ECT. It didn't say anything more so, my curiosity aroused, I flicked a quick email to the MHRT office asking for a copy of the lecture.
Fairly quickly, a response arrived: "No. You can't have it." For somebody who doesn't surprise easily, I was surprised, and not a little offended: What's their game? Who do they think they are? You can't declare scientific material secret, it's in the open, that's one of the most basic rules of science. So I sent a firmly worded email pointing out that the lecturer could not present any material that was not readily available in the scientific literature. They had no authority to declare public knowledge secret retroactively, and I wanted to see it, as is my right under the Right To Information Act (RTI, Qld's version of the freedom of information acts elsewhere).
In due course, an equally firmly worded response arrived: The ECT lecture is exempt from the provisions of the RTI Act as it relates to the tribunal's "quasi-legal" functions, and such functions are excluded from the purview of the RTI in all government agencies.
That was ridiculous. There was no way medical information could be reclassifed as legal and kept secret. In another email, I pointed out that the provisions of the RTI covered material related to individual patients. If they were going to throw the "quasi-legal" net over standard medical procedures, then they could classify the location of the toilets in their building as related to the tribunal's quasi-legal functions and keep that secret, too. There had to be a limit, and that limit did not extend as far as taking chunks of medical information and locking it away. So I lodged a formal application under the RTI, which was rejected, as was the appeal. The last step was an appeal to something called the Office of the Information Commissioner (OIC). I stated:
In view of the Public Service principles of transparency, accountabilty and the overriding duty of care of the Government and Public Service to disabled or disadvantaged members of the public, especially to those whose civil rights have been curtailed through no fault of their own, I submit that there is no justification for the secrecy over this material. Specifically, there is no good reason to withhold it, and the blanket rejection of requests on the basis that the material may relate to “quasi-judicial functions” is so broad that it removes the MHRT from any conceivable review when there is an overriding public interest in ensuring that the actions of the MHRT are beyond reproach.
The essential point is that the MHRT is not just some "quasi-judicial body" officiating over disputes over fences or noisy neighbours and so on, it takes a person's control over his or her own life and hands that control to another person to do, essentially, anything. I also wanted a copy of the test the MHRT uses to determine that material is or is not "quasi-judicial," and what tests they used to ensure that the material was balanced. As expected, they don't have such tests, they make it up as they go. Needless to say, the OIC ruled against my appeal just on the basis that, as "quasi-judicial material," the lecture was secret. If I want to appeal, it goes to the Qld Civil and Administrative Appeals Tribunal (QCAT), but appeals are on points of law only, not the crucial point which is: Does the MHRT have the authority to declare scientific material relating to basic human rights to be secret? QCAT will side with them because the MHRT alone makes the decision whether material is "quasi-judicial."
My position is that the speaker at the lecture was "highly likely" to be a person who uses ECT and who therefore gains financially from using it (even if you use it while employed by the Government, you're still gaining). In the case of private psychiatrists, it is in their interest to encourage the MHRT to grant more orders relating to ECT on involuntary patients as they will gain directly (the only figure I have came from about five years ago from a private hospital in Brisbane, which charged $620 per episode, divided among the hospital, the anaesthetist and the psychiatrist; at the time, the Medicare rebate for ECT, MBS Item 14224, was $70.35; patients could expect to pay something like $400 out of pocket each time for a treatment they didn't want).
It is also directly in their interest to encourage the MHRT to believe that, as the Royal Australian and New Zealand College of Psychiatrists (RANZCP) claims, ECT is "useful," "essential," "irreplaceable," "effective," "valuable," "clinically indicated," "important and necessary," and harmless, while opposition to it is "irrational," out-dated and not scientific. That way, the MHRT is more likely than not to grant orders for involuntary treatment. Involuntary treatment, in case you don't know, can be ordered if the patient "unreasonably refuses" treatment. So if you are in a hospital as a voluntary patient, the psychiatrist says you should have ECT and you decline the offer, you can immediately be detained and you will get it. From which, of course, everybody makes a very large profit.
Some years ago, I was asked by a reporter to comment on ECT. In due course, an article appeared in the Brisbane rag which cast serious doubt on the RANZCP claims. Very quickly, an anonymous complaint was lodged with the College, saying I was being nasty. I was not allowed to see the complaint nor cross-examine the complainants and, after their usual secret investigation, I was found guilty of some thought crime or other, I didn't actually read it, and they were going to "mark my record accordingly." Just in case they thought that had impressed me, I published a review of the claims made by RANZCP above, and found each and every one of them false (reference at end).
Briefly, rates of use of ECT vary dramatically from one country to the next, from one city to the next and even within a single city. There are places in the world where it is banned, other places where it just isn't used, and most where (unlike Australia) it is fairly severely restricted. The best example is Italy, where it was actually invented in 1938. Italian mental hospitals in the 1960s and 70s were truly terrible so, in 1978, a law was passed (called the Basaglia Law) which closed most of them and severely restricted use of ECT. Needless to say, ECT supporters around the world were horrified, and predicted a wave of suicides as Italians were deprived of their "irreplaceable, scientific, humane, cost-effective" treatment. And equally needless to say, nothing happened, there was no disaster. In fact, the Law was a great success. Today in Italy, ECT is restricted to about 15 licensed centres (some of which don't use it), meaning some 50million Italians don't have access to it. There is zero evidence to say they are any the worse for it. None. Not one jot nor tittle of evidence nor even a skerrick. The whole hysterical outburst was driven by people who make heaps of money from ECT and who believe mental disorder is a brain disease and don't want anybody to find out it isn't.
Using evidence provided by psychiatrists who use and advocate for ECT, I showed that each claim was false. It is not safe; it is not effective; patients don't like it; it has no scientific basis; "clinical indication" has no scientific meaning; it is not important and it is seen as "necessary" only for people who (a) make lots of money from it, or (b) who believe that all mental disorder is physical (for which they have no evidence and no model) or (c) who don't know what else to do because they have no model of mental disorder. Finally, it most definitely isn't cheap: a course of ECT costs far more than treatment by psychotherapy.
My paper showed that the primary driver for the excessive use of ECT in Australia is the immense profits it generates for the private psychiatric industry (psychiatrists and hospitals - many of which are owned in foreign tax havens) and private anaesthetists. If anybody disagrees with this, I would like to see their evidence.
Needless to say, I have not heard a word of apology from the RANZCP since that paper was published, nor do I expect to. It is in their interest to keep ECT quiet so the public forget about it (many people believe it was dropped in the 1970s) and, as my little exchange with the MHRT shows, to quietly convince officials with the power to authorise it that they should do so. I will write to the president of the MHRT with one final appeal: morality. We will see if that softens their legalistic hearts. Don't bet on it.
The reference for the ECT paper:
McLaren N (2017). Electroconvulsive Therapy: A Critical Perspective. Ethical Human Psychology and Psychiatry 19: 91-104. DOI: 10.1891/1559-4343.19.2.91 (I can't post it here but if anybody wants a copy, email me).
(In 2019, the college journal Australasian Psychiatry published a long paper cheering for 80 years of ECT. Entitled Hip Hip Hooray, ECT turns 80! it was written by a psychiatrist who is "Director of Transcranial Magnetic Stimulation, Ramsay Health, North Adelaide." The psychiatrist reported "No conflicts of interest." My response to the paper, entitled Hollow Cheers for ECT was, of course, rejected).
Great article