Recurrent Themes in ECT/EST Practice: Ethics, Consent and the Law
Worldwide, there is considerable variation in prevalence estimates of EST administration with minors. In the United States it has been estimated that between 500 and 3,500 minors are given EST each year ( Thompson & Blaine, 1987). Between American states, prevalence rates also vary; to date in four states EST with minors is prohibited. Exact data have been hard to obtain, as reporting of EST with minors sometimes has been obscured by flawed documentation. EST usage with minors is widespread in some "centers of excellence" (e.g., Mayo Clinic, Washington) despite recent negative media attention.
Throughout the world, shock prevalence rates vary between countries. In Germany, the Netherlands and Norway, ECT is not used with minors, after the introduction of tough mental health legislation. Elsewhere in Europe rates vary considerably between countries. In the United Kingdom, weak mental health legislation has set the occasion for increased use of ECT since the beginning of the 1990s. A recent unpublished Royal College of Psychiatrists report found widespread use of shock with minors throughout the United Kingdom, despite overselective methods of data gathering and a weak audit methodology.
In Spain, Belgium and France it has been reported that ECT is administered to children, although exact prevalence rates are not known. France was the European originator of electroshock following initial work completed in the mid-1940s ( Heuyer et al., 1947). In other European countries, although it is known that ECT is administered to minors, confirmation is hard to obtain, due to the absence of published scientific reports and inadequate accounts of mental health legislation.
In some developing countries, use of electroshock has been poorly documented. EST with minors is known to occur in all continents, including