Rewiring practice: community mental health professionals’ attitudes towards and knowledge of electroconvulsive therapy in the context of advance decision-making

Abstract

Purpose In England, electroconvulsive therapy (ECT) cannot be administered to service users who make an advance decision to refuse the treatment, unless in life-threatening circumstances. In a sector where person-centred practice is revered, no prior research has investigated whether community mental health practitioners (CMHPs) encourage service users to make advance decisions about ECT. This study aims to explore whether CMHPs have supported advance decision-making about ECT and whether their profession, attitudes towards and knowledge of the treatment affect this. Design/methodology/approach A quantitative online survey was completed by n = 120 CMHPs (nurses, social workers and occupational therapists). The validated Questionnaire on Attitudes and Knowledge of ECT was used. Findings In total, 93% of participants knew service users who had undergone ECT, yet only 12% had supported a service user to make an advance decision about ECT. Compared to those who had not supported advance decision-making, those who had shown significantly higher knowledge and a more positive attitude. Nurses and those who had worked in the mental health field for over 10 years had significantly higher knowledge of ECT. Originality/value CMHPs are well placed to support advance decision-making about ECT. Increased knowledge about advance decisions and ECT may bolster the uptake of advance decision-making, thus greater training is recommended.