Concerns Raised Over Unmodified Electroconvulsive Therapy at Central Institute of Psychiatry, India

A recent article published in the Times of India sheds light on a worrying practice at the Central Institute of Psychiatry (CIP) in India.

Despite laws forbidding it, the institute still uses a controversial treatment known as “direct” or “unmodified” electroconvulsive therapy (ECT).

(1) Notwithstanding anything contained in this Act, the following treatments shall
not be performed on any person with mental illness—
(a) electro-convulsive therapy without the use of muscle relaxants and
anaesthesia;
(b) electro-convulsive therapy for minors; — Page 39, Section 95 of India’s The Mental Healthcare Act (MHCA) of 2017, prohibited procedures *116GI.p65 (mohfw.gov.in)

This treatment, done without anesthesia and muscle relaxants, can be risky and traumatic for patients.

Despite laws prohibiting it, the Central Institute of Psychiatry (CIP) in India continues to administer electroconvulsive therapy (ECT) without anesthesia. This troubling practice has raised ethical concerns and prompted questions about patient rights.

A doctor who worked at CIP revealed that this practice persists because many patients are uneducated, unaware that they can request modified ECT.

“…’they continue to do it in CIP taking advantage of the fact that the majority of the patients are uneducated and belong to low socioeconomic sections and do not know enough to demand modified ECT,’ said a doctor who had worked in CIP.”

Additionally, some psychiatrists argue that direct ECT should be allowed in resource-poor settings because it is perceived as equally safe and inexpensive:

“Some psychiatrists argue that direct ECT ought to be allowed in resource poor settings since direct ECT was “just as safe and cheaper’.”

Even though CIP has resources for safer alternatives, it continues to use this outdated method.

This raises ethical concerns and questions about patient rights. Despite authorities being alerted to these issues, no action has been taken. According to Times of India article:

“In August 2022, the National Human Rights Commissions (NHRC) had expressed serious concern over the apathetic attitude of the authorities in CIP towards providing quality mental health care.“

“CIP being a centrally funded institution, queries on this issue were sent to the union health ministry and the office of the CIP director. Neither have responded. If they respond, the article will be updated online.”