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Psychiatric advance directives and consent to electroconvulsive therapy (ECT) in Australia: A legislative review and suggestions for the future

Overview

This paper examines psychiatric advance directives (PADs) and electroconvulsive therapy (ECT) regulation across Australian jurisdictions. PADs allow people with mental illness to document treatment preferences while they have capacity, for implementation during future crises when capacity is lost. The research reveals complex, inconsistent legislation across states/territories, with no jurisdiction permitting binding PADs for involuntary patients except limited ECT refusal in ACT.

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Individual authors

  • Kay Wilson
  • Subramanian Purushothaman
  • Uday Kolur

Key insights

Key Insights:

  1. PADs originated from 1960s-70s anti-psychiatry movements challenging coercive psychiatric treatment

  2. All Australian jurisdictions except Tasmania have strict ECT regulations requiring informed consent

  3. No state permits binding PADs for compulsory mental health patients generally

  4. ACT provides strongest protection - tribunals cannot order ECT if refused in PAD

  5. Complex legislation spans multiple acts creates confusion for clinicians and patients

  6. Only 2.34% of Victorian hospital patients had advance statements on record (2016-17)

  7. ECT is most commonly refused treatment (42%) followed by depot injections (25%)

  8. Authors recommend partially binding PADs, clearer legislation, and improved clinical involvement

Did this resource draw on transformative evidence?

<p>The document does not appear to be based on direct experiential expertise from people with lived experience of mental illness or PADs. The authors are academics from law and psychiatry backgrounds. While they reference a clinical vignette about "Mary" (noted as a real but de-identified case included with patient consent), the paper is primarily a legislative review and legal analysis rather than experiential research.</p>
<p>This document was not based primarily on practice wisdom. It was a legislative review that conducted systematic analysis of laws across all Australian states and territories regarding psychiatric advance directives (PADs) and electroconvulsive therapy (ECT). While it incorporated some clinical insights and referenced research on implementation challenges, the methodology was fundamentally legal analysis rather than practice-based inquiry or clinical experience.</p>
<p>This document was primarily based on legal analysis rather than research and evaluation insights. While it referenced some existing research on PAD implementation, uptake rates, and clinical concerns, the core methodology was legislative review and comparison across Australian jurisdictions. The paper cited studies showing low PAD utilisation (2.34% in Victorian hospitals) and clinician attitudes, but these were supporting evidence rather than the foundation of the analysis.</p>

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Literature Review