85 Australasian Psychiatry • Vol 19, No 1 • February 2011 for the treatment of a non-psychi- atric disorder under the MHA. This is not correct. Sections 91 and 93 of the MHA set out detailed provisions allowing the application of ECT to a patient who is able to give informed con- sent to the procedure. Nothing in these provisions prohibits using ECT for the treatment of neurolog- ical illnesses, provided the patients treated are not involuntary patients and are capable of providing valid consent. It is true, as the authors highlight, that this section makes reference to a specified form, and also true that on this form, under a heading ‘Possible benefits of treat- ment’, it reads: “Benefits depend on the symptoms of the conditions for which treatment is given. Relief may be obtained from symptoms of depression, agitation and insomnia”. 3 However, there is no suggestion that these listed symp- toms are supposed to represent an exhaustive list. The form is clearly designed to include specific refer- ence only to those symptoms most likely to be suffered by people undergoing ECT for major depres- sion. Arguably, the form might be better worded given ECT relieves a range of other symptoms, but it cannot be argued that the form’ s current wording in any way prohib- its ECT for any symptoms not listed. If that were true, the form would prohibit ECT’ s use in psychoses such as schizophrenia, which are obviously routine applications. The form can be readily used to provide consent to ECT adminis- tered for neurological disorders such as Parkinson’ s disease. It sim- ply requires that the person gain- ing the consent, augment and explain the information on the form. Finally, the authors also state that patients in NSW who are unable to NSW law, ECT and DBS DEAR SIR, In their recent paper, Loo et al. write passionately of what they take to be overly burdensome legal obstacles to the application of elec- troconvulsive therapy (ECT) and deep brain stimulation (DBS) in all Australian legislatures and in New South Wales in particular. 1 They argue that the current legislative regime discriminates against some people with psychiatric and neuro- logical illness who will, as a result, be prohibited from accessing these sometimes life-saving treatments. While agreeing with the thrust of their arguments, it is important to make some corrections to their paper as the situation is not quite as restrictive as they suggest and a misunderstanding of the actual legal situation may further inhibit patient access to these important therapies. First, between the time that their paper was accepted and its publica- tion, the regulations attached to the Mental Health Act 2007 (NSW) (hereafter the MHA) changed so that the Act now permits the use of DBS for patients with Tourette syn- drome, chronic tic disorder, tremor and dystonia as well as Parkinson’ s disease. 2 Consequently, it is now possible to use DBS to treat a range of neurological illnesses for which there is strong evidence of efficacy. Second, the authors state that in NSW “there is no mechanism” by which a patient can be given ECT doi: 10.3109/10398562.2010.539223  2011 The Royal Australian and New Zealand College of Psychiatrists CORRESPONDENCE give valid consent cannot access ECT for the treatment of a non- psychiatric disorder. This is also incorrect. While it is apparent that legislators did not anticipate the extraordinarily rare circumstance where an incapacitious person with a non-psychiatric disorder might benefit from ECT, it is also apparent that it was not Parliament’ s inten- tion to prohibit such access. In 2008 one of us (CJR) argued before a magistrate and then the Mental Health Review Tribunal that a patient with a several month his- tory of intractable status epilepti- cus, but no psychiatric illness, should first be considered a “men- tally ill person” under the MHA by virtue of her “serious disorder of thought form”, 4 and then should receive ECT as it offered her the best chance of recovery and survival from her grave neurological condi- tion. 5 Each proposition was accepted by those conducting the indepen- dent reviews and the patient’ s sei- zures abated with the ECT. Psychiatrists must play a promi- nent role in the ongoing reform of mental health legislation, but it is important not to overstate exist- ing legal restrictions, at the risk of further limiting the availability of legitimate medical treatment. REFERENCES Loo C, Trollor J, Alonzo A 1. et al . Mental health legis- lation and psychiatric treatments in NSW: electro- convulsive therapy and deep brain stimulation. Australasian Psychiatry 2010; 18: 417–425. Mental Health Regulation 2007 (NSW) cl 12. 2. Mental Health Regulation 2007 (NSW) schedule 1, 3. form 6. Mental Health Act 2007 (NSW) ss 3 & 14. 4. Mental Health Act 2007 (NSW) s 94. 5. Christopher Ryan and Sascha Callaghan Sydney, NSW Australas Psychiatry Downloaded from informahealthcare.com by University of Sydney on 02/16/11 For personal use only.