Scots subjected to involuntary electroconvulsive therapy in 2024, audit finds

Scotland faced renewed scrutiny over the use of electroconvulsive therapy as an official audit found thousands of ECT treatments were administered in 2024, including a significant share delivered without patient consent. The Scottish ECT Audit Network reported that 4,135 treatments were carried out on 264 patients that year, with about half of those patients aged 60 or older and roughly six in ten being women. A notable portion of the cases involved patients who were deemed unable to consent due to the severity of their illness, and in 1,081 instances patients or their families objected to the treatment but were overruled by clinicians. The findings come as international bodies have warned that involuntary ECT may breach human rights and could amount to torture under certain circumstances.

The audit also documented safety concerns and side effects. Adverse incidents were recorded 31 times and included prolonged seizures, dental damage, cardiovascular events, and prolonged confusion. Memory problems were reported by about 24.9% of patients. Despite these concerns, the report states that 88.8% of patients showed improvement after the treatment. The Scottish Government noted that every ECT prescription is overseen by the Mental Welfare Commission for Scotland and the Mental Health Tribunal for Scotland, arguing that ECT can be lifesaving for some individuals with severe, treatment-resistant mental health conditions and that appropriate safeguards are in place for patients who cannot consent.

Experts and opponents of the procedure weighed in on the findings. Dr John Read, a professor of clinical psychology at the University of East London and author of several studies on ECT, criticized the practice as unethical and unscientific. He argued that involuntary ECT cannot be justified ethically, saying that the therapy has historically been developed under standards that are no longer acceptable and that its claimed benefits do not extend beyond the treatment period. He called for an immediate suspension of ECT until rigorous research is conducted to establish its effectiveness.

The audit’s figures underscore a broader, long-running debate about the balance between potential short-term gains and long‑term risks. While the Scotland report notes that most patients who received ECT improved, independent research has highlighted memory impairment and cognitive effects associated with the procedure. In a 2023 survey of 858 ECT patients, 80% reported memory recall issues and 70% reported difficulty retaining new information, with many effects persisting for more than three years in a substantial share of cases. A separate study of more than 1,000 ECT patients published in Circulation found that more than half believed the treatment was not helpful and that a majority reported a decline in quality of life following ECT.

Global health authorities have weighed in on the rights implications. A 2023 joint position from the World Health Organization and the United Nations concluded that ECT administered without consent violates the right to physical and mental integrity and may constitute torture in some circumstances. The Scottish Government stressed that ECT is used for the most unwell patients and that legal safeguards are intended to protect those who cannot consent, while acknowledging the procedure can carry adverse effects and requires ongoing scrutiny. The balance between patient safety, clinical need, and ethical considerations remains contentious as clinicians, patients, and families navigate difficult treatment decisions in Scotland and beyond.