Citizens Commission on Human Rights

The Mental Health Watchdog

Australian National Office

SA Psychiatrists Want to Keep Being Able to Electroshock Children and Now Want to Make Restraint Use Easier to Give Involuntary Electroshock

The SA Mental Health Act is under review

Feedback closes 12 January 2024

Electroshock is legal for use on all ages including children, pregnant women and the elderly in SA and there are no proposals to change this.

The SA Chief Psychiatrist has now proposed that the authorisation for restraint to forcibly give involuntary electroshock is not obtained through a Tribunal. Instead he proposes the SA Mental Health Act is changed to allow for psychiatrists to give authorisation for the use of the restraint. This can only increase the use of restraint and could affect involuntarily detained children who are treated without parental consent. Currently restraint to give electroshock can only be done for “urgent” electroshock and then only with Tribunal approval.1

What is Electroshock (ECT): Also called electroconvulsive therapy, it is the application of hundreds of volts of electricity to the head to create a seizure (convulsion). It can cause brain damage, permanent memory loss, heart problems, stroke and death. In SA it can be given up to four times in one session to establish how much electricity is needed for a convulsion. ECT is not therapy, it is torture. Most people think ECT is already banned and it should be.2

  • In SA in 2022-23, there were 6,218 electroshocks given to 509 people. The SA Chief Psychiatrist reported that this included 0–19-year-olds as well as elderly over 90 years of age.3

What is Restraint: 1) The use of physical force to control or hold down a patient 2) Mechanical restraint-̶ the use of cuffs, straps etc to restrict movement such as being cuffed to a bed and 3) Chemical restraint ̶ the use of psychiatric drugs to subdue and control someone. Restraint is traumatic and it can and does cause death. Restraint use is rife in SA.

  • In 2022-23 in SA, there were 1,739 physical restraint instances, 44 instances of mechanical restraint and 697 chemical restraint events.4

The United Nations (UN) and World Health Organisation (WHO) together issued a Guidance on mental health and human rights legislation in October 2023. It states, “coercive practices in mental health care violate the right to be protected from torture or cruel, inhumane and degrading treatment.” Coercive practices include restraint and involuntary electroshock. The Guidance calls on all governments to prohibit all coercive measures.5

  • The Guidance says that electroshock is an “irreversible intervention” which can cause “memory loss and brain damage.”  6
  • As long ago as 2013, the UN called on all countries to impose a total ban on all forced interventions including involuntary electroshock and restraint.7
  • And in 2019, the United Nations directly told Australia it should, “Prohibit the use of non-consensual electroconvulsive therapy on the basis of any form of impairment.”8
  • In 2021, the WHO said it was important for countries to eliminate practices that restrict the right to give consent which includes involuntary electroshock and restraint.9

SA has still not banned restraint or involuntary electroshock and there are no current proposals to ban either. Apart from the fact both barbaric restraint and electroshock should already be illegal, to take away Tribunal approval to give restraint for electroshock as the Chief Psychiatrist proposes, can only increase the use of traumatic restraint on involuntarily detained patients.10 Recommendations: 1) Both restraint and involuntary electroshock must be banned immediately. They are both torture and should be made criminal offences. 2) Psychiatrists should not be able to authorise restraint to give involuntary electroshock.

Electroshock of SA Children: The 2023 UN and WHO Guidance states, “ECT is not recommended for children, and this should be prohibited through legislation.”11

The SA law allows for the use of ECT on children including involuntary ECT without any parental consent needed. WA has made a start to rectify this area with a ban ECT on children under 14 years of age and ACT ban it for children under 12 years of age.12 The SA Chief Psychiatrist does not recommend ECT is banned for children in his Discussion Paper on the review of the SA Mental Health Act. Recommendation: Electroshock must be prohibited on children immediately.

TAKE ACTION

Lodge a submission by Friday 12 January 2024

Please express your concerns and request the below is done:

  1. Electroshock is prohibited for children per the UN and WHO Guidance.
  2. A psychiatrist should not be able to authorise restraint so they can forcibly give involuntary electroshock. This should not be legalised in the SA Mental Health Act.
  3. Involuntary electroshock is banned per the UN and WHO instructions.

Send your submission by:

Email: HealthOCP@sa.gov.au

Mail: Office of the Chief Psychiatrist, PO Box 287, Rundle Mall, Adelaide, SA 5000.

Email a copy of your submission to:

The Minister for Health and Wellbeing, the Hon Chris Picton: ministerforhealth@sa.gov.au

Shadow Minister for Health : Mrs Ashton Hurn: schubert@parliament.sa.gov.au

Please tell others so they too can take action.

Read the Discussion Paper here.


References

  1. Response to the Review of the Mental Health Act 2009, Discussion Paper, Government of South Australia, SA Health, November 2023, pages 23, 24. https://ehq-production-australia.s3.ap-southeast-2.amazonaws.com/7fe40c1c3d68591b96ff8d3cf97f68524d186046/original/1698985100/61c5c801b4fd0d54cbce5e801fb9d142_Draft_Discussion_Paper_Review_of_MHAct.pdf
  2. Electroconvulsive Therapy (ECT) Devices for Class II Draft Guidance for Industry, Clinicians and Food and Drug Administration Staff, US Food and Drug Administration, 29 December 2015, pages 13,14. https://www.fdanews.com/ext/resources/files/2016/01/01-16-FDA-ECT.pdf?1451949526; ECT Policy Guideline – Guiding Document, Titration Charts, SA Office of Chief Psychiatrist, Heath Department for health and Wellbeing, Government of South Australia, see under heading, “Titration guidelines.” https://s3-ap-southeast-2.amazonaws.com/sahealth-ocp-assets/general-downloads/ECT-Policy-Guideline-Document-Titration-Charts.pdf
  3. Annual Report of the Chief Psychiatrist of South Australia, 2022-23, Tabled SA Parliament in House of Assembly, 29 November 2023, p.28. https://www.chiefpsychiatrist.sa.gov.au/news/30-november-2023
  4. Annual Report of the Chief Psychiatrist of South Australia, 2022-23, Tabled SA Parliament in House of Assembly, 29 November 2023, p.44. https://www.chiefpsychiatrist.sa.gov.au/news/30-november-2023
  5. Mental Health, human rights and legislation, Guidance and practice, Geneva: World Health Organisation. United Nations Human Rights, Office of the High Commissioner, 9 October 2023, pages 15,58,72,73. https://www.who.int/publications/i/item/9789240080737
  6. Mental Health, human rights and legislation, Guidance and practice, Geneva: World Health Organisation. United Nations Human Rights, Office of the High Commissioner, 9 October 2023, p.58. https://www.who.int/publications/i/item/9789240080737
  7. Mental Health, human rights and legislation, Guidance and practice, Geneva: World Health Organisation. United Nations Human Rights, Office of the High Commissioner, 9 October 2023, p.15. https://www.who.int/publications/i/item/9789240080737
  8. “Concluding observations on the combined second and third periodic reports of Australia,” Committee on Rights of Persons with Disabilities, 15 October 2019, https://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=6QkG1d%2FPPRiCAqhKb7yhsnzSGolKOaUX8SsM2PfxU7sdcbNJQCwlRF9xTca9TaCwjm5OInhspoVv2oxnsujKTREtaVWFXhEZM%2F0OdVJz1UEyF5IeK6Ycmqrn8yzTHQCn
  9. Guidance on Community Mental Health Services: Promoting Person-Centered and Rights-Based Approaches, World Health Organisation, 10 June 2021, pages.4,6,7,8, https://www.who.int/publications/i/item/9789240025707 (to download report).
  10. Response to the Review of the Mental Health Act 2009, Discussion Paper, Government of South Australia, SA Health, November 2023, p. 24. https://ehq-production-australia.s3.ap-southeast-2.amazonaws.com/7fe40c1c3d68591b96ff8d3cf97f68524d186046/original/1698985100/61c5c801b4fd0d54cbce5e801fb9d142_Draft_Discussion_Paper_Review_of_MHAct.pdf
  11. Mental Health, human rights and legislation, Guidance and practice, Geneva: World Health Organisation. United Nations Human Rights, Office of the High Commissioner, 9 October 2023, p.58. https://www.who.int/publications/i/item/9789240080737
  12. Western Australia Mental Health Act 2014, 3 November 2023, s194, p. 146, https://www.legislation.wa.gov.au/legislation/statutes.nsf/main_mrDtle_13534_homepage.html; Australian Capital Territory Mental Health Act 2015, s147 (3), p. 177, 16 November 2023. https://www.legislation.act.gov.au/a/2015-38