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. Method: 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.