The NALNECT committee has been working closely with ECTAS to develop the first National ECT Nurse Course. Based on a set of competencies created by NALNECT and ECTAS workers, further details are available via the link to the ECTAS website. The first of the 3 day courses, to be held in January, February and March 2009 are already booked up. However, to date, there are still places available on the course starting in April 2009 in London and starting in September 2009 in Leeds. Members of the NALNECT committee will be involved in the training and will organise the refresher sessions for this course, with the support of ECTAS. The course will include assessment by completion of a workbook, completion of a competency document and evidence of participation in a minimum of ten ECT sessions. Accreditation for this course by the Royal College of Nursing, is being sought.

On the 4th June 2008, NALNECT hosted the Second National ECT Nurse Conference. This time it was held at the De Montfort University, Leicester.  Again it was deemed a success with 97% of attendees, who completed evaluation forms, stating they would attend such an event again. The day was chaired by the RCN Mental Health Advisor and opened with an outstanding presentation by a service user from Hull, who had recovered from his illness following ECT. Other highlights included a presentation, by a psychiatrist who had travelled from Scotland, on the theories around how ECT works. One of the main benefits of attending the conference was the opportunity to network with other ECT nurses around the country.  Other speakers included a psychiatrist and anaesthetist from Sussex, a nurse consultant from Manchester, members of the ECTAS team, an ECT nurse manager from Bodmin and a pharmacist from the Novartis company. The NALNECT committee would like to thank the sponsors of the event, the ECT machine suppliers, Dantec Dynamics and Micromed Electronics. Thanks also to Novartis Pharmaceuticals Ltd for their sponsorship.

If you are a registered mental health nurse working in an ECT department in England, Wales or Ireland you are currently eligible for membership of a regional ECT nurse special interest group, please contact us for details of your nearest group, via the Contact us page of this site. Or, if you are interested in setting up a regional group with other ECT nurses, we are able to give ongoing practical advice and support. We may also, if required / requested, visit and help chair your first meeting.

The National Association of Lead Nurses in ECT, (NALNECT), would like to point out that ECT has come a long way from the old media caricature. Responsibly administered by an appropriately trained team, with modern equipment, in environments fit for purpose, it has been shown to treat people with severe depression and save their lives. There is proper selection and screening of patients for ECT, in accordance with the criteria outlined in the “NICE guidelines 2003″.

 We feel strongly that ECT should not be banned, as recent research shows that 70 % of patients who received the treatment showed significant clinical benefits. It should continue to be available for selected patients suffering from depressive illness. ECT (electroconvulsive therapy) is recognised as an effective intervention by the World Health Organisation and by medical authorities and clinical experts worldwide.

 Depression is a serious illness that affects at least one in four of us at some time in our lives. It brings with it distress and suffering for the individual and their family. It takes its toll on relationships, work and achievement in life. It is associated with a significant mortality and suicide risk. Treatments for depression include counselling, psychotherapy, antidepressant medication and mood stabilisers.

However, a number of patients are not fortunate enough to respond to these treatments or combinations of them. A number of patients experience depression of such severity that risk is increased by waiting for the standard treatments to possibly work, which can be weeks to months.

There is a strong evidence base from scientific research that ECT is not only effective but also that it is life-saving in some cases. Treatment with ECT has been shown to have a profound effect in reducing suicide in the short term, and as mental health nurses with responsibility for our patients, we must never lose sight of this.

When ECT was first introduced, it was used for a wider range of mental illnesses and disorders. Clinical research and audit have allowed us to identify the patients whose clinical condition responds well to ECT. The increase in the availability and sophistication of other treatments for depression, including cognitive behaviour therapy and other forms of psychotherapy, along with greater choice of antidepressant medications, has meant that more patients recover without the need to consider ECT. Other patients, when they have ECT and respond, wonder why they have had to wait so long to be offered this treatment.

The administration of ECT has changed remarkably in recent years and bears little resemblance to the caricatured presentation sometimes seen in the media. Patients have a full medical assessment to ensure their suitability for a general anaesthetic.

All patients have a full general anaesthetic and a muscle relaxant before a short controlled seizure of about 30 seconds is induced. The patient is closely monitored throughout by specially trained staff. A consultant anaesthetist monitors their anaesthesia and recovery. The entire process is supervised by a consultant psychiatrist.

ECT in England is closely regulated by the Mental Health Act Commission, which has written rules for its prescription and a detailed code of practice. This ensures the prescription and administration of ECT is of a very high standard of practice. Many centres in England who administer ECT also participate voluntarily in an accreditation programme run by the Royal College of Psychiatrists to ensure their service is at the cutting edge.

So what is the evidence that ECT works? An audit in Scotland of all patients receiving ECT, published in 2000, showed that over 70 per cent made significant clinical improvement. Many of these patients had failed to respond to antidepressant medication and made a significant recovery after treatment with ECT. The UK review group on ECT published an article in the Lancet in 2003, concluding that ECT remained an important treatment option for the treatment of severe depressive illness.

Systematic review of patients who have had ECT shows that they have a positive view of their experience of ECT.

What about the potential side effects? There is some evidence of memory impairment after ECT, a retrograde amnesia, more associated with bilateral treatment than unilateral treatment. In 2007, a leading researcher in ECT reported that 10 per cent of patients were still experiencing some memory difficulties after six months. We expect that this number will fall significantly with contemporary ECT practice. Another area of current research showing promise concerns the mode of action of ECT. Recent work has shown growth of new nerve cells in the part of the brain regulating emotion following ECT.

ECT has a long-established proven efficacy in the treatment of depression. It is not a first-line treatment but a vitally important intervention option. Standards of administration and regulation must be kept high so that our patients and families are informed and aware of the potential benefits and possible side effects – and this of course applies to many medical interventions. This important treatment must not be evaluated on the view of individuals, but on the well-recognised and evidence-based positive outcomes experienced by patients.

NALNECT committee.

In September 2006, NALNECT organised the First National ECT Nurse Training Conference, which took place in Hull. Deemed a successful event, over 100 hundred delegates attended. The importance and benefits of becoming a member of one of the regional ECT nurse special interest groups was emphasised. Most of these S.I.G.s meet quarterly and provide specialist peer group supervision, unavailable elsewhere. ECT, despite its now proven effectiveness in the treatment of severe depression, remains surrounded in controversy. Therefore, mental health nurses working in this field can feel quite isolated, even from their colleagues in psychiatry. Networking provides an opportunity to compare practice, express anxieties and frustrations. Problem solving, presentations, creating documents that are of use in practice, are just some of the many activities that take place at these meetings.

 

NALNECT wishes to encourage more mental health ECT nurses to join their local ECT nurse special interest group.

It is with great pleasure that I find myself writing my first Chairpersons report and I suspect this will be the first we have on our NALNECT records.

 

I find it hard to believe that we have achieved so much since our first Executive Committee was elected at St.Annes Hospital, Dorset on the 18^th of February 2003, the joint Chairs at that time being Brian M. and Yvonne F.

 

Since then we have met 15 times and our list of achievements are extensive, here follows what I would consider to be the main ones:-

 

1. The organisation of two National Conferences, the first in Hull in September 2006 and the most recent in Leicester in June of this year.

Both of these events were attended by over 120 delegates and more importantly had active patient involvement in the form of attendees and speakers, please note that I use the term ‘patient’ at the request of those ‘patients/ex patients’ who attended the Leicester Conference who were very clear that that is what they wished to be called .

 

2. The establishment of a core set of Nurse Competencies which have since been adopted by the Royal College of Psychiatrists and now form the foundation of the SHO Training.

 

3. Active work with ECTAS regarding the implementation and review of their standards.

 

4. The establishment of international links within Europe, America and Australia.

 

5. Recognition amongst other national organisations re the benefits of working with NALNECT and the experience of the practitioners within it, the RCN,DOH,RC Psych, RCA to mention a few.

 

6. The request by the Minister of Health to attend a meeting at the Houses of Parliament to participate in a discussion regarding the use of ECT and how that could be best incorporated into the ‘New’ Mental Health Act 2007.

 

7. The promotion and establishment of further Special Interest Groups, Midlands are now up and running and a South East /London Group is on the horizon.

 

8. The provision of support and advice to colleagues within ECT Depts across the country.

 

9. I think we can be particularly proud over the last year of the establishment of an Award for ECT Nurses who wish to pursue and promote good practice / practice development. The decision as to which Team/Teams receives the £1000 award will be made at our October meeting with the RCN’s Mental Health Advisor attending in order to ensure we have an independent person on the panel.

 

10. We must also remember the work that has been done with ECTAS with regard to the development and planned roll out of a National ECT Nurse Training Package

 What does the future hold for NALNECT, ‘how longs a piece of string’ as the saying goes, there are a few certainties, we will be organising a 3^rd National Conference the venue is still being negotiated, however it will be in either Leeds, Manchester or Birmingham, the first NALNECT Nurses Award will be allocated later this year and the first ECT Nurse Training course will take place in january, february and march 2009, an excellent example of partnership working between NALNECT and ECTAS.

 

We will also continue as an organisation to promote the formation of Special Interest Groups across the country, this has been somewhat of a problem but we did make some positive contacts at the most recent Conference which should enable us to push ahead with this.

 

Technology is always somewhat of a thorny issue for me but in order that NALNECT can become a more accessible organisation we will continue with our endeavours to create our own website, this has proved to be a difficult task for us and will be one of our priorities for the rest of the year.

 

I would like to take this opportunity to thank all committee members for their continued support and hard work during our time together and extend a special THANKYOU from the Committee itself to Stephen F. and Jan  T. (and their colleagues back at base) who have been the backbone of the Conference organisation and planning and without who I don’t think we could have done it, let alone made them the successes they were. And of course to Alison F.  who has faithfully recorded our discussions and ensured we get our minutes in time for each meeting.

 

 Thank you for your time

 

 

 

Rebecca

NALNECT CHAIRPERSON

10.07.08