Chief Psychiatrist policy
This interactive flowchart sets out the requirements of the Chief Psychiatrist's Electroconvulsive therapy (ECT) policy (PDF 2521 kB). It includes the mandatory regulatory requirements for the approval and performance of ECT to ensure appropriate safeguards are in place for patients.
The Chief Psychiatrist's ECT policy is mandatory for all authorised mental health services (AMHSs). An authorised doctor, authorised mental health practitioner, AMHS administrator, or other person performing a function or exercising a power under the Mental Health Act 2016 must comply with the policy.
What is electroconvulsive therapy (ECT)
ECT is a regulated treatment under the Mental Health Act 2016. It's an evidence-based treatment for certain severe psychiatric disorders.
The Chief Psychiatrist has fact sheets and information for patients and support persons about what ECT is, how it works and its risks and benefits. There are also clinical guidelines and resources available for clinicians and AMHS staff.
Interactive flowchart
This interactive flowchart sets out the mandatory requirements for the approval and performance of ECT. Clinicians can use it to help inform decisions about including ECT as part of a patient's treatment or care.
| Question Id (Enter as a capital Q and a number no spaces) | Question or Statement | Response | Go to Question or Outcome (based on response selected) |
|---|---|---|---|
| Q1 | This interactive flowchart demonstrates how the Chief Psychiatrist policy for Electroconvulsive therapy sets out the regulatory requirements for the approval and performance of ECT to ensure appropriate safeguards are in place. The policy is mandatory for all authorised mental health services (AMHSs). An authorised doctor, authorised mental health practitioner, AMHS administrator or other person performing a function or exercising a power under the Mental Health Act 2016 must comply with the policy. | Continue | Q2 |
| Q2 | Is ECT proposed for treatment of–
| Mental illness | Q3 |
| Other condition/s | Outcome12 | ||
| Q3 | Is emergency ECT proposed for the person? For emergency ECT to be performed, it must be necessary to save the person's life, or to prevent the person from suffering irreparable harm. | Yes, emergency ECT is proposed | Outcome11 |
| No, emergency ECT is not proposed | Q4 | ||
| Q4 | Is the person–
| They're an adult | Q5 |
| They're a minor | Outcome10 | ||
| Q5 | A person (who is an adult) can give informed consent to ECT, even if they are currently subject to a treatment authority, forensic order or treatment support order. A person has the capacity to give informed consent if they are able to:
| Continue | Q6 |
| Q6 | Does the person currently have capacity to give informed consent to ECT? | Yes, they have capacity | Q8 |
| No, they don't have capacity | Q12 | ||
| I'm not sure | Q7 | ||
| Q7 | If it is not clear if the person has capacity to give informed consent to ECT, the doctor may consider obtaining a second opinion from another psychiatrist to confirm the person's current capacity to provide informed consent. | Continue (back to previous question) | Q6 |
| Q8 | You need to obtain informed consent directly from the personBefore the person can give informed consent to undergo ECT, the doctor proposing the treatment must give a full explanation to the person about:
| Continue | Q9 |
| Q9 | Has the person given informed consent to undergo ECT? | Yes, they have given informed consent | Q10 |
| No, they refuse to give informed consent | Q11 | ||
| Q10 | Is the person currently subject to any of the following–
| Yes | Outcome1 |
| No | Outcome2 | ||
| Q11 | Is the person currently subject to any of the following–
| Yes | Outcome3 |
| No | Outcome4 | ||
| Q12 | Does the person have an advance health directive that discusses ECT? A person can give informed consent to ECT in an advance health directive. This can be relied on if the person does not have capacity to provide consent at the time the ECT is proposed. | Yes | Q13 |
| No | Outcome9 | ||
| Q13 | Does the advance health directive appear to give clear directions about their views, wishes and preferences for ECT? For example, does the person's directions reflect, as much as possible, that they understand:
Note: The person's directions can give (or refuse to give) informed consent to ECT. | Yes | Q15 |
| No | Outcome8 | ||
| I'm not sure | Q14 | ||
| Q14 | If the person's directions appear to be invalid or not clear, then the doctor may obtain a second opinion from another psychiatrist to help confirm:
| Continue (back to previous question) | Q13 |
| Q15 | Does the person's directions (in their advance health directive) give informed consent to ECT? | Yes, it gives informed consent | Q16 |
| No, it refuses to give informed consent | Outcome7 | ||
| Q16 | Is the person currently subject to any of the following–
| Yes | Outcome5 |
| No | Outcome6 |
Outcome 1
ECT can be performed if approved by the MHRT
The MHRT may give approval if satisfied the doctor gave the full explanation at the time the person gave informed consent.
Note: Each application to the MHRT is unique and determined on a case-by-case basis.
Next steps
The doctor will need to complete the Consent agreement for ECT form and document the capacity assessment.
The doctor will also need to apply to the MHRT by completing the Regulated treatment application for ECT form. If a second opinion was obtained, it must accompany the application to the MHRT.
As soon as practicable after applying for approval, the doctor must:
- tell the person the application has been made, and
- explain the application to the person.
More information
Refer to the Chief Psychiatrist policy for Electroconvulsive therapy (opens in new window) at:
- section 2.1.1 (Patients subject to involuntary treatment under the Act)
- section 3 (Performance of ECT with MHRT approval)
- section 5 (MHRT decisions for treatment applications)
Additional resources can also be found on the Treatment and care page (opens in new window) on the Mental Health Act 2016 website–under Regulated treatment (Electroconvulsive therapy)
Outcome 2
ECT can be performed
An application to the MHRT for approval to perform ECT is not required, as the person has provided informed consent and is not currently subject to a treatment authority, forensic order or treatment support order.
Next steps
The doctor will need to complete the Consent agreement for ECT form and document the capacity assessment.
Note: The doctor does not need to subsequently make a treatment authority to perform ECT for the person.
More information
Refer to the Chief Psychiatrist policy for Electroconvulsive therapy (opens in new window) at section 2.1.2 (Patients receiving voluntary treatment)
Additional resources can also be found on the Treatment and care page (opens in new window) on the Mental Health Act 2016 website–under Regulated treatment (Electroconvulsive therapy)
Outcome 3
ECT can be performed if approved by the MHRT
If a person subject to a treatment authority, forensic order or treatment support order is assessed as having capacity at the time and refuses to give informed consent, then ECT cannot be performed. However, this does not preclude an application being made to the MHRT or emergency ECT being provided if the criteria are met.
An MHRT application (if progressed) allows for the assessment of the person's capacity to give informed consent to be confirmed by the MHRT in recognition of the potential vulnerabilities that the person (as an involuntary patient) may have in relation to providing consent for ECT.
Note: Each application to the MHRT is unique and determined on a case-by-case basis.
Next steps
To apply to the MHRT, the doctor will need to complete the Regulated treatment application for ECT form. If a second opinion was obtained, it must accompany the application.
The application must explain why ECT has clinical merit and is appropriate in the circumstances, as well as various other considerations in the MHRT's form.
Remember to also document the capacity assessment and that the person refused to give consent.
As soon as practicable after applying for approval, the doctor must:
- tell the person the application has been made, and
- explain the application to the person.
More information
Refer to the Chief Psychiatrist policy for Electroconvulsive therapy (opens in new window) at:
- section 2.1.1 (Patients subject to involuntary treatment under the Act)
- section 3 (Performance of ECT with MHRT approval)
- section 4 (Performance of ECT in an emergency)
- section 5 (MHRT decisions for treatment applications)
Additional resources can also be found on the Treatment and care page (opens in new window) on the Mental Health Act 2016 website–under Regulated treatment (Electroconvulsive therapy)
Outcome 4
ECT cannot be performed
If a person receiving voluntary treatment has capacity and refuses to give informed consent to undergo ECT, this decision must be respected and ECT cannot be performed.
If an application for approval to perform ECT is made to the MHRT, it is likely that the MHRT will reject the application in this instance.
Next steps
Remember to document the capacity assessment and that the person refused to give informed consent.
More information
Refer to the Chief Psychiatrist policy for Electroconvulsive therapy (opens in new window) at section 2.1.2 (Patients receiving voluntary treatment)
Additional resources can also be found on the Treatment and care page (opens in new window) on the Mental Health Act 2016 website–under Regulated treatment (Electroconvulsive therapy)
Outcome 5
ECT can be performed if approved by the MHRT
The MHRT will check that the advance health directive reflects that, at the time it was made, the person appeared to receive the full explanation required and gave informed consent to undergo ECT.
Note: Each application to the MHRT is unique and determined on a case-by-case basis.
Next steps
The doctor will need to document consent provided in the advance health directive in the Consent agreement for ECT form and apply to the MHRT by completing the Regulated treatment application for ECT form. If a second opinion was obtained, it must accompany the application.
As soon as practicable after applying for approval, the doctor must:
- tell the person the application has been made, and
- explain the application to the person.
More information
Refer to the Chief Psychiatrist policy for Electroconvulsive therapy (opens in new window) at:
- section 2.1.1 (Patients subject to involuntary treatment under the Act)
- section 3 (Performance of ECT with MHRT approval)
- section 5 (MHRT decisions for treatment applications)
Additional resources can also be found on the Treatment and care page (opens in new window) on the Mental Health Act 2016 website–under Regulated treatment (Electroconvulsive therapy)
Outcome 6
ECT can be performed
An application to the MHRT for approval to perform ECT is not required, as the person has provided informed consent and is not currently subject to a treatment authority, forensic order or treatment support order.
Next steps
The doctor will need to complete the Consent agreement for ECT form and document the capacity assessment.
Note: The doctor does not need to subsequently make a treatment authority to perform ECT for the person.
More information
Refer to the Chief Psychiatrist policy for Electroconvulsive therapy (opens in new window) at section 2.1.2 (Patients receiving voluntary treatment)
Additional resources can also be found on the Treatment and care page (opens in new window) on the Mental Health Act 2016 website–under Regulated treatment (Electroconvulsive therapy)
Outcome 7
ECT can be performed if approved by the MHRT
If the person has made a direction in an advance health directive which refuses to give informed consent to ECT, the doctor may consider:
- obtaining a second opinion from another psychiatrist regarding the person's capacity to give (or refuse to give) informed consent
- applying to the MHRT for approval to perform ECT if the doctor is not satisfied the advance health directive can be relied upon in the circumstances or it appears to be invalid or not clear.
An MHRT application (if progressed) allows for the assessment of the person's capacity to give informed consent to be confirmed by the MHRT in recognition of the potential vulnerabilities that the person may have in relation to providing consent for ECT.
Note: Each application to the MHRT is unique and determined on a case-by-case basis.
Next steps
To apply to the MHRT, the doctor will need to complete the Regulated treatment application for ECT form. If a second opinion was obtained, it must accompany the application.
The application must explain why ECT has clinical merit and is appropriate in the circumstances, as well as various other considerations in the MHRT's form.
As soon as practicable after applying for approval, the doctor must:
- tell the person the application has been made, and
- explain the application to the person.
More information
Refer to the Chief Psychiatrist policy for Electroconvulsive therapy (opens in new window) at:
- section 2.1 (Requirements for obtaining informed consent)
- section 3 (Performance of ECT with MHRT approval)
- section 5 (MHRT decisions for treatment applications)
Additional resources can also be found on the Treatment and care page (opens in new window) on the Mental Health Act 2016 website–under Regulated treatment (Electroconvulsive therapy)
Outcome 8
ECT can be performed if approved by the MHRT
The doctor must take into account the person's views, wishes and preferences, including in their advance health directive before making an application to the MHRT.
In deciding whether or not to approve ECT, the MHRT must consider any views, wishes and preferences of the person, including in their advance health directive. If applicable, the MHRT may also consider whether the person had capacity to give informed consent at the time they made their advance health directive.
Note: Each application to the MHRT is unique and determined on a case-by-case basis.
Next steps
To apply to the MHRT, the doctor will need to complete the Regulated treatment application for ECT form. If a second opinion was obtained, it must accompany the application.
The application must explain why ECT has clinical merit and is appropriate in the circumstances, as well as various other considerations in the MHRT's form.
As soon as practicable after applying for approval, the doctor must:
- tell the person the application has been made, and
- explain the application to the person.
More information
Refer to the Chief Psychiatrist policy for Electroconvulsive therapy (opens in new window) at:
- section 2.1 (Requirements for obtaining informed consent)
- section 3 (Performance of ECT with MHRT approval)
- section 5 (MHRT decisions for treatment applications)
Additional resources can also be found on the Treatment and care page (opens in new window) on the Mental Health Act 2016 website–under Regulated treatment (Electroconvulsive therapy)
Outcome 9
ECT can be performed if approved by the MHRT
In deciding whether or not to approve ECT, the MHRT must consider any views, wishes and preferences of the person.
Note: Each application to the MHRT is unique and determined on a case-by-case basis.
Next steps
The doctor will need to apply to the MHRT by completing the Regulated treatment application for ECT form. If a second opinion was obtained, it must accompany the application.
The application must explain why ECT has clinical merit and is appropriate in the circumstances, as well as various other considerations in the MHRT's form.
As soon as practicable after applying for approval, the doctor must:
- tell the person the application has been made, and
- explain the application to the person.
More information
Refer to the Chief Psychiatrist policy for Electroconvulsive therapy (opens in new window) at:
- section 2.1 (Requirements for obtaining informed consent)
- section 3 (Performance of ECT with MHRT approval)
- section 5 (MHRT decisions for treatment applications)
Additional resources can also be found on the Treatment and care page (opens in new window) on the Mental Health Act 2016 website–under Regulated treatment (Electroconvulsive therapy)
Outcome 10
ECT can be performed if approved by the MHRT
A minor, or their parent or guardian, cannot give informed consent to undergo ECT. However, ECT can be approved by the MHRT.
The MHRT can approve an application to perform ECT if satisfied that all of the following apply:
- performing ECT has clinical merit and is appropriate in the circumstances
- evidence supports the effectiveness of ECT for the minor's particular mental illness and persons of the minor's age
- if ECT has previously been performed on the minor–of the effectiveness of ECT for the minor
- performing ECT on the minor is in the minor's best interest.
The MHRT must also have regard to the views, wishes and preferences of the minor, as well as the views of the minor's parents.
Note: Each application to the MHRT is unique and determined on a case-by-case basis.
Next steps
To apply to the MHRT, the doctor will need to complete the Regulated treatment application for ECT form. If a second opinion was obtained, it must accompany the application.
As soon as practicable after applying for approval, the doctor must:
- tell the person the application has been made, and
- explain the application to the person.
More information
Refer to the Chief Psychiatrist policy for Electroconvulsive therapy (opens in new window) at:
- section 2 (Performance of ECT with consent)
- section 3 (Performance of ECT with MHRT approval)
- section 5 (MHRT decisions for treatment applications)
Additional resources can also be found on the Treatment and care page (opens in new window) on the Mental Health Act 2016 website–under Regulated treatment (Electroconvulsive therapy)
Outcome 11
Emergency ECT can be performed for relevant patients
ECT may be performed in an emergency if the person is a relevant patient–that is, a person:
- subject to a treatment authority, forensic order or treatment support order, or
- absent without permission from an interstate mental health service and detained in an AMHS.
An application must still be made to the MHRT for approval to perform ECT, but emergency ECT may be performed before the application is heard by the MHRT.
Next steps
The doctor and the senior medical administrator of the relevant patient's treatment health service must complete the Certificate to perform emergency ECT form. This must immediately be provided to the AMHS administrator so they can immediately forward it to the MHRT.
An application will still need to be made to the MHRT, if not already done, by completing the Regulated treatment application for ECT form.
To the greatest extent practicable, the doctor must:
- tell the person about the certificate for emergency ECT, and
- explain the certificate to the person.
The certificate for emergency ECT is in force for the period:
- starting on the day the application to the MHRT was made, and
- ending on the day the application is determined by the MHRT.
More information
Refer to the Chief Psychiatrist policy for Electroconvulsive therapy (opens in new window) at section 4 (Performance of ECT in an emergency)
Outcome 12
Seek advice from your local HHS legal unit
The Mental Health Act 2016 only makes provision for the use of ECT for treatment of mental illness.
While a very infrequent occurrence, ECT may also be considered for treatment of other medical conditions (such as epilepsy). However, the Mental Health Act 2016 cannot be applied to authorise ECT in these circumstances.
The Guardian and Administration Act 2000 deems ECT to be 'special health care' and specifically excludes the Queensland Civil and Administrative Tribunal (QCAT) from providing consent for ECT.
In the absence of a legislative framework to authorise ECT for a condition other than a mental illness, consideration may be given to making an application to the Supreme Court in its parens patriae jurisdiction. This is an inherent jurisdiction of the Supreme Court to protect individual interests and it covers both adults lacking capacity and children.
Advice from the local Hospital and Health Service legal unit should be sought in the first instance.
Feedback and help
We value your feedback. Tell us what you think about the ECT interactive flowchart.
The Chief Psychiatrist's Mental Health Act liaison service offers free advice and information about the mandatory requirements for ECT. You can call or email the service for advice.