In a specially extended column, Phil Barker welcomes aspects of the NICE guidance on ECT. But, he warns, the treatment remains both ‘dubious and dangerous’

The National Institute for Clinical Excellence published its longawaited technology appraisal of electroconvulsive therapy (ECT) at the end of April (NICE 2003). Almost immediately the recommendations attracted criticism from psychiatrists who were hoping for more clinical authority over its use. Matt Muijen, director of the Sainsbury Centre for Mental Health, was scornful of the attempt to address the lack of consent noted repeatedly in several previous reports. He told the Guardian that the ‘guidance states that patients can make advanced directives to refuse treatment but these have no legal basis. A psychiatrist knows that in such cases the patient usually recovers after four sessions of ECT and will get a second opinion and go ahead despite the patient’s decision’ (Batty 2003). This echoed the anger expressed by Scottish psychiatrists who, earlier this year, voiced concerns about the ‘mythologies around ECT’ saying these ‘have been reinforced by negative portrayals in the media’ and might put people off from accepting the treatment. In the view of Donald Lyons, from Gartnavel Hospital in Glasgow: ‘ECT is a modern and valid treatment which saves many people’s lives and relieves suffering’ (Royal College of Psychiatrists 2003).