A Focus Group Study of Indian Psychiatrists' Views on Electroconvulsive Therapy under India's Mental Healthcare Act 2017: ‘The Ground Reality is Different’

Abstract

Background:India's Mental Healthcare Act, 2017 (MHCA) greatly restricts the use of electroconvulsive therapy (ECT) in minors and bans unmodified ECT. Indian psychiatrists have raised concerns that these measures may deprive certain patients of life-saving treatment. This study describes the perspectives of Indian psychiatrists on how ECT is dealt with in the legislation.Methods:We conducted nine focus groups in three Indian states. We explored the positive and negative implications of the MHCA and discussed its implementation, especially in relation to ECT.Results:Many of the themes and concerns commonly discussed in relation to ECT in other jurisdictions are readily apparent among Indian psychiatrists, although perspectives on specific issues remain heterogeneous. The one area of near-universal agreement is Indian psychiatrists' affirmation of the effectiveness of ECT. We identified three main areas of current concern: the MHCA's ban on unmodified ECT, ECT in minors, and ECT in the acute phase. Two broad additional themes also emerged: resource limitations and the impact of nonmedical models of mental health. We identified a need for greater education about the MHCA among all stakeholders.Conclusion:Core concerns about ECT in India's new legislation relate, in part, to medical decisions apparently being taken out of the hands of psychiatrists and change being driven by theoretical perspectives that do not reflect “ground realities.” Although the MHCA offers significant opportunities, failure to resource its ambitious changes will greatly limit the use of ECT in India.

Exploring Psychiatrists’ Experiences During Transition from Mental Health Act, 1987 to Mental Healthcare Act, 2017 in Goa, India

“…The Indian mental health services, crippled with resource allocation, are pushed to brink with the implementation of new legislation. 17…”

What are the ethical dilemmas in the decision‐making processes of nursing people given electroconvulsive therapy? A critical realist review of qualitative evidence

“…A brief review of research from places such as India and China would indicate similar discussions around consent, legal issues, provision of information about ECT and public perception (e.g. Duffy et al, 2017; Li et al, 2016; Zong et al, 2020). There is a broad spectrum of approaches towards ECT internationally, with some countries completely banning its use feeling it is too dangerous and invasive to use, while other countries utilize ECT at nearly every psychiatric unit, with some of those countries still practising unmodified forms of the treatment (Gazdag et al, 2017).…”

Perceptions regarding the Indian Mental Healthcare Act 2017 among psychiatrists: Review and critical appraisal in the light of CRPD guidelines

“…However, it is important to note that some of these concerns are subjective and lack substantial evidence to support them. Treatment-related concerns: The IMHCA 2017 incorporates provisions that necessitate meticulous documentation of assessments and treatment outcomes by mental health professionals to safeguard the rights of individuals with mental illness. However, numerous psychiatrists express concern that the increased time spent on administrative tasks and detailed documentation might curtail valuable patient engagement for clinical discussions (Duffy and Kelly, 2019a; Duffy et al, 2019b; Harbishettar et al, 2019b). …”

“…While the new act aligns with CRPD guidelines, emphasizing the promotion, protection and realization of complete and equitable human rights, legal capacity, equality and dignity for PwMI, it has faced diverse criticism from various stakeholders, particularly psychiatrists (Duffy et al, 2019a , 2019b ; Korulla, 2019 ). Despite the progressive nature of the IMHCA, its implementation has encountered challenges.…”