Electroconvulsive therapy (ECT)

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Consenting to ECT

This page covers the following:

• How do I make an informed choice and give consent?
• Can I be given ECT without my consent?
• Advance decisions about ECT

How do I make an informed choice and give consent?

You have the right to make an informed decision about whether or not to accept the treatment a doctor suggests. To consent properly you need enough information to be able to weigh up the risks and benefits of having it.

You should be given full information, in language you can understand, about:

• the expected benefits of the treatment
• any side effects and the risk of harm
• how the treatment will be given
• alternative treatments
• the alternative of having no treatment at all.

It can be hard to take in a lot of new information in one go, so you can ask for medical staff to explain it to you more than once if necessary.

You should be given 24 hours to think about your decision.

The ECT Accreditation Service (ECTAS) recommends that you have a friend, relative or advocate with you when you are given the information, so that they can go over it with you again.

What happens if I decide to consent to ECT?

If you agree to the treatment, you will have to sign a written consent form. Once you have signed a consent form, you should be informed that you can change your mind at any stage in the treatment and that, if you do, the treatment will be stopped.

You should also be told how you can tell staff if you have changed your mind. At each stage of the treatment, the doctor should confirm with you that you are continuing to consent.

ECTAS recommends that, if you decide to go ahead with having ECT but your relatives or close friends disagree with this treatment, this should also be recorded in your notes.

See our page on deciding whether to have ECT for more information about making this decision.

Can I be given ECT without my consent?

You may be given ECT without your consent if you need emergency treatment or if you don't have capacity to consent to it.

Emergency treatment

The Mental Health Act 1983 sometimes allows ECT to be given without your consent in an emergency, but only if the treatment is immediately necessary for any of the following reasons:

• If it will save your life.
• If it will prevent your condition seriously worsening, and won't have unfavourable physical or psychological consequences that can't be reversed.

If you do not have capacity to give consent

If you don't have capacity to give consent, treatment may be given under the Mental Health Act 1983 or, less commonly, under the Mental Capacity Act 2005.

Under some sections of the Mental Health Act 1983

If you have been detained under certain sections of the Mental Health Act 1983, you may be given ECT without your consent if all of the following apply:

• You are detained under the Mental Health Act 1983, except if you are detained under sections 4, 5(2) or 5(4).
• You are unable to understand the information about ECT and cannot give informed consent.
• You have not previously made an advance decision, or there is not a decision made by an attorney, deputy or the Court of Protection refusing ECT treatment.
• A second opinion specialist who is not involved in your care consults with two people who have been professionally involved with your care and also agrees that ECT should be given.

Under the Mental Capacity Act 2005

If you are not detained under the Mental Health Act 1983, you may still be treated without your consent under the Mental Capacity Act 2005. This can only happen if all of the following apply:

• You are assessed as lacking capacity to consent under the Mental Capacity Act 2005.
• You have not previously made an advance decision refusing ECT treatment.
• It is considered to be in your best interests to receive the treatment.

Before a decision is made on whether ECT is in your best interests, various people need to be consulted, including:

• anyone interested in your welfare, such as a carer or close family member
• your attorney (if you have appointed one) and deputy (if the Court of Protection has appointed one).

If there is a disagreement over whether ECT is in your best interests, it may be necessary to apply to the Court of Protection to resolve this disagreement.

Advance decisions about ECT

If you are clear you do not wish to receive ECT even if your life is in danger, your advance decision needs to meet special conditions.

ECT should not be given to you if any of the following conditions apply:

• You have already made a valid and applicable advance decision refusing ECT.
• Your attorney has refused ECT on your behalf under a lasting power of attorney.
• A court-appointed deputy, or a court, has refused ECT on your behalf.

Your family should also be consulted in all of these cases, if appropriate.

This information was published in July 2019. We will revise it in 2022.

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