Mental health legislation and psychiatric treatments in NSW: electroconvulsive therapy and deep brain stimulation.
OBJECTIVE
The aim of this paper is to discuss the restriction of electroconvulsive therapy (ECT) to the treatment of psychiatric disorders and the prohibition of psychosurgery and deep brain stimulation (DBS) in the NSW Mental Health Act 2007 (MHA), and to examine these restrictions from clinical and human rights perspectives.


METHODS
Sections of the NSW MHA regulating the use of ECT, psychosurgery and DBS were reviewed. These were compared with corresponding regulations in mental health legislation in other Australian states. Reasons for discrepancies were explored.


RESULTS
Restrictions in the MHA on the use of ECT, psychosurgery and DBS are not in line with current clinical evidence of their efficacy and safety. The prohibitions aim to ensure safeguards are in place but the legislation fails to balance these objectives with the potential clinical benefit offered by these treatments.


CONCLUSIONS
By imposing restrictions which are not justifiable in terms of the clinical evidence available, the MHA discriminates against those with neurological disorders responsive to psychiatric treatments, and those with psychiatric disorders who would benefit from the development of DBS as a treatment.
Loo
Colleen
C
School of Psychiatry, University of NSW, St George Hospital, Gray Street, Kogarah, NSW 2217, Australia. colleen.loo@unsw.edu.au
Trollor
Julian
J
Alonzo
Angelo
A
Rendina
Nicola
N
Kavess
Rosemary
R
D046690:Deep Brain Stimulation; D004565:Electroconvulsive Therapy / Q000331:legislation & jurisprudence*; D006806:Human Rights; D007883:Legislation, Medical / Q000639:trends*; D008603:Mental Health; D009422:Nervous System Diseases / Q000628:therapy; D009517:New South Wales; D011570:Psychiatry / Q000331:legislation & jurisprudence*; D011612:Psychosurgery; D018570:Risk Assessment