Carers' views on psychosocial treatments and Electroconvulsive Treatment (ECT)

Some carers discussed the access of the person being cared for to a range of non-pharmaceutical treatments. This Talking Point describes carers’ views on the place of these approaches in the person cared for’s treatment, how successful they thought they were and other treatments they would like to have available for the person being cared for.

Talking therapies

Some carers felt that talking therapies (referred to generally as counselling by many) were very beneficial to the person cared for. A few carers described Cognitive Behavioural Therapy (CBT) and mindfulness meditation as particularly helpful for the person being cared for; these therapies were received both in hospital and in private health care and undertaken by psychiatrists and psychologists. Ballagh’s son, for example, did mindfulness exercises as part of his day program at a public hospital and found it relaxing.

Lisa felt that ‘talking’ therapy was often most effective for her brother. She said that although resources were so ‘skint’ in public hospitals, they were making more use of talking therapies.

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Well, knowing my brother and knowing his illness the way I do now after 19 years, I think talking to him is the most effective therapeutic. And unfortunately, because resources are so skint in public wards, that’s not something that really happens very much. So what I’ve observed is, if he is upset about something, or quite distressed, you know, if you’re able to have a conversation with him and draw out what he’s feeling and just acknowledge what he’s feeling, it’s a hell of a lot more effective than what often happens in the public wards.

Which is, they [say], “Oh, here, have some Valium and, you know, go and have a sleep”. So it’s very distressing because obviously I can’t be there at the ward 24/7. So you would hope that staff would, and I think it’s starting to get better. They’re starting to use more of those interventions before jumping purely to pharmaceuticals.

Julie’s daughter received cognitive behavioural therapy (CBT) from her psychologist, which gave her ‘insight’ into her experiences and greater ability to share this with others.

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Yeah, and it’s hard to understand. She’s tried to explain it to me that it just paralyses her that there’s something that she feels, she says, “I know it doesn’t make sense, it’s not logical, it’s anxiety. This whole thing is that it’s a fear of something that’s not actually real, but that’s what you feel anyway”. So she’s understanding her own self better which I think has helped. [This] has come about by having the cognitive behaviour therapy training and the sessions with the psychologist so that she can now identify things.

In fact, actually, yes, she did say these last few weeks, she’s been able to identify that she’s waiting. And it’s okay to wait for things to happen and not to be worried that it’s going to be like this forever. So that’s, I guess, a good sign of knowing that there will be different times in your life where things are happening. But it’s not going to be like that forever.

Electroconvulsive Treatment (ECT)

Electroconvulsive Treatment is a medical procedure where a titrated dose of electricity is administered through paddles applied to specific areas on the head to induce controlled seizures. The recipient receives a brief general anaesthetic.

Having ECT suggested as treatment for the person being cared for by mental health practitioners was described as confronting by all carers who had experience of this. One carer, Tracey, was not aware that it was still performed as a treatment and, similar to other carers, only knew the procedure ‘from the movies’. While a few carers knew this was likely to be an inaccurate portrayal of the procedure, for them it was nonetheless ‘alarming’.

In the case of Lisa’s brother, being a compulsory patient meant that neither she nor her brother felt they were sufficiently informed about ECT, because Lisa said a nurse advised her that practitioners did not legally have to consult them in the decision. ECT was proposed a number of times to Tracey’s partner who considered having the procedure because she said she did not ‘feel like anything was going to help’. Tracey and her partner made the decision together not to go ahead with the procedure. Looking back, Tracey said they both felt that this had been the right decision.

Lisa was initially uncomfortable with the thought of ECT and her brother did not want it. Eventually he agreed to it and she said that ‘clinically’ it made ‘a really big difference’ for him.

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But in that admission, because he was non-responsive to medication and so unwell they made the decision to start ECT. And I remember when they called me to tell me that they were doing that, I said, “Oh, I don’t know. I don’t much about ECT. I’m going to need to look into this”. And they just said, “Well, he’s involuntary. We don’t need your permission”. And I thought, ‘Oh, okay, what does that even mean?’

Was this a psychiatrist talking to you like this, or a nurse or …

It was a nurse, yeah, a nurse in the regional hospital that he was in, which was different to the first hospital that he’d been in. But I remember those words very clearly, because they made me quite upset. Because I just felt, ‘Oh, great, he’s going to be … ‘ – you know, thinking back to those old-school movies where they’ve used ECT, – ‘Oh great, he’s going to convulse around and have his brain nuked, you know’. But it turned out clinically to be positive, so it did make a really big difference for him.

Tracey had a significant role in her partner’s decision not to have ECT.

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We weren’t made to feel pressured. The ECT was done onsite. They had an ECT portion of the hospital. So it was just given as an option of treatment at that hospital. So we weren’t really pressured to make that decision within any certain timeframe. I guess I was pretty – I was a, “No”, pretty quickly and she was a “Yes”, and then it was a period of, you know, finding out why [she was], “Yes”, and probably me convincing her that, “I don’t think we’re at that stage yet. Maybe just give it a go in here. It’s your first, you know, first hospitalisation. There could be other things that will help first”. It was, yeah, quite a concerning treatment option to me.

And how soon did you say in the end, having consulted her about her reasons?

I would say it would have probably been the first week. As I said, when she’s with major depression, she’s quite submissive. So, I guess, she kind of lent on me to be the one of reason, I suppose, in that me saying that I don’t think it’s a good idea, she went, “All right”. So, it was probably about a week, a week and a half, of discussing it and her receiving that inpatient treatment, which had already started, so she could see some of the benefits of just the hospital stay itself.

Looking back later, has she ever expressed to you an opinion about that process around the decision that was made about ECT?

Yeah, later, later on. Probably all the time now she says it. That, “I’m so glad that you said, don’t do it”. She said, “Because I was at my wits’ end and I was willing to try it, but I’m glad I didn’t. I’m glad I didn’t do it”. During that course of that first hospitalisation, she met someone that was doing it, and so saw the effects on her of the treatment, you know, well, pretty much the hour after, and being the [same] day. And since then, since becoming well, she’s [said] she’s awfully glad she didn’t do it, and [that] she just gave in.